BIOPSYCHOSOCIAL MODEL OF DEPRESSION AND MARITAL DISCORD

描述(改编自申请者摘要)：抑郁症是 国家面临的最普遍和最严重的心理健康问题， 痛苦、社会和职业残疾的重大后果， 身体疾病和过早死亡。拟议的研究将评估 用于理解抑郁症发生的发育生物心理社会模型 在婚姻不和的情况下。具体地说，这种素质-压力 模型提出，导致抑郁的一个途径是婚姻的发生 一小部分人之间的不和谐(即最近的社会压力) (A)自尊心主要集中在人际关系上 (即，具有社会性认知人格风格的人；远端 心理素质)，和/或(B)有下丘脑-垂体-肾上腺 (HPA)轴调节失调(即，谁对紧张的人际关系做出反应 皮质醇高反应性事件；远端生物素质)。它 进一步预测，这些心理和生物疾病可能 部分原因是(C)儿童时期的重大损失(即父母死亡 或离婚；远端发育素质)。调查这件事 一体化模式不仅应有助于进一步理解 抑郁症的发展、维持和缓解，但也可能提供 发展防治方法的方向 抑郁症。 为了评估这一发育的生物心理社会模型，对160个样本进行了分析 情侣将被招募参加一个由两个小组组成的多方法 评估将包括访谈、观察、生物学和 采用问卷调查法进行评估。A 2(抑郁状态，基于 症状严重程度和DSM-III-R标准)x 2(不和谐状态)因素 将使用设计来测试假设的主和交互 抑郁和婚姻不和对(A)负性情绪和 消极情感互惠，(B)社会性认知-人格风格， (C)基线皮质醇和皮质醇反应性，以及(D)童年丧失。 配偶将(A)完成抑郁、婚姻不和、 个性风格和童年失落；(B)当他们讨论 愉快的事件，并试图解决他们关系中的两个问题；以及 (C)观看录像带，并提供对其影响的持续评级 回忆在婚姻冲突中的经历(即解决问题) 互动。唾液皮质醇将在前、中和 冲突后互动和视频回想之后。 抑郁和婚姻不和的严重程度将在3-、6-和 在最初评估后的9个月内，夫妇将完成 在12个月的随访中进行同样的综合评估。纵向的 这项研究的组成部分旨在评估(A) 生理、心理和发展方面的疾病(即，他们是否 是特质还是状态标志)；以及(B)抑郁症严重程度是否发生变化 是由生理机能(社会亲和性)之间的相互作用预测的 认知-个性风格、皮质醇反应性)在 两个时期婚姻不和的初步评估和变化。

DESCRIPTION (Adapted from Applicant's Abstract): Depression is one of the most prevalent and serious mental health problems facing the nation, with substantial consequences of suffering, social and occupational disability, physical illness, and premature mortality. The proposed study will evaluate a developmental biopsychosocial model for understanding depression occurring in the context of marital discord. Specifically, this diathesis-stress model proposes that one pathway to depression is the occurrence of marital discord (i.e., a proximal social stressor) among a subgroup of individuals (a) whose self-esteem is largely invested in interpersonal relatedness (i.e., who have a sociotropic cognitive-personality style; a distal psychological diathesis), and/or (b) who have hypothalamic-pituitary-adrenal (HPA) axis dysregulation (i.e., who respond to stressful interpersonal events with cortisol hyper-reactivity; a distal biological diathesis). It is further predicted that these psychological and biological diatheses may result, in part, from (c) major loss during childhood (i.e., parental death or divorce; a distal developmental diathesis). Investigating this integrative model should serve not only to further understanding of the development, maintenance, and remission of depression, but may also offer directions for developing methods for the prevention and treatment of depression. To evaluate this developmental biopsychosocial model, a sample of 160 couples will be recruited to participate in a two-panel, multi-method evaluation that will include interview, observational, biological, and questionnaire methods of assessment. A 2 (Depression status, based on symptom severity and DSM-III-R) criteria) x 2 (Discord status) factorial design will be employed to test the hypothesized main and interactive effects of depression and marital discord on (a) negative affect and negative affect reciprocity, (b) sociotropic cognitive-personality style, (c) baseline cortisol and cortisol reactivity, and (d) childhood loss. Spouses will (a) complete measures of depression, marital discord, personality style, and childhood loss; (b) be videotaped as they discuss a pleasant event and attempt to solve two problems in their relationships; and (c) view the videotape and provide a continuous rating of the affect they recall experiencing during the marital conflict (i.e., problem-solving) interactions. Salivary cortisol will be sampled pre-, mid-, and post-conflict interaction and after the video recall. Severity of depression and marital discord will be assessed at 3-, 6-, and 9-months following the initial assessment, and couples will complete the same comprehensive evaluation at a 12-month follow-up. The longitudinal component of the study is designed to evaluate (a) the stability of the biological, psychological, and developmental diatheses (i.e., whether they are trait vs. state markers); and (b) whether change in depression severity is predicted by the interactions between the diatheses (sociotropic cognitive-personality style, cortisol reactivity) measured during the initial assessment and change in marital discord between the two periods.