BIOPSYCHOSOCIAL MODEL OF DEPRESSION AND MARITAL DISCORD

描述（改编自申请人的摘要）：抑郁症是一种 国家面临的最普遍和最严重的心理健康问题， 痛苦、社会和职业残疾的严重后果， 身体疾病和过早死亡。 拟议的研究将评估 一个理解抑郁症发生的发展生物心理社会模型 在婚姻不和的情况下。 具体来说，这种素质压力 模型提出，抑郁症的一个途径是婚姻的发生， 不和谐（即，近端的社会压力源） (a)他们的自尊主要是建立在人际关系上 (i.e.,具有亲社会性认知人格风格的人; 心理素质），和/或（B）具有下丘脑-垂体-肾上腺皮质功能的人 (HPA)轴失调（即，对紧张的人际关系 皮质醇高反应性事件;远端生物素质）。 它 进一步预测，这些心理和生物素质可能 部分原因是（c）童年时期的重大损失（即，父母死亡 或离婚;远端发展素质）。 调查这 综合模式不仅应有助于进一步了解 发展，维护和缓解抑郁症，但也可能提供 制定预防和治疗 萧条 为了评估这种发展的生物心理社会模型，样本160 夫妇将被招募参加一个两个小组，多方法 评估将包括访谈、观察、生物学和 问卷调查评估方法。 A2（抑郁状态，基于 症状严重程度和DSM-III-R）标准）× 2（不一致状态）析因 设计将被用来测试假设的主要和互动 抑郁症和婚姻不和对（a）消极影响和 负性情感互惠，（B）亲社会认知人格风格， (c)基线皮质醇和皮质醇反应性，和（d）童年损失。 配偶将（a）完成抑郁，婚姻不和， 人格风格和童年损失;（B）在他们讨论时进行录像 愉快的事件，并试图解决他们关系中的两个问题; (c)观看录像带，并提供一个持续的影响评级， 回忆婚姻冲突期间的经历（即，解决问题） 交互. 唾液皮质醇将被采样前，中期， 冲突后互动和视频回忆后。 抑郁症和婚姻不和的严重程度将被评估为3-，6-， 9-在初步评估后的几个月内，夫妇将完成 在12个月随访时进行相同的综合评价。 纵向 研究的组成部分旨在评价（a） 生物、心理和发育素质（即，他们是否 是特质与状态标记）;和（B）抑郁症严重程度的变化是否 是由素质之间的相互作用预测的（亲社会性 认知人格风格，皮质醇反应）， 两个时期之间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.