Role of the family in recovery and major depression.

OBJECTIVE Major depression is significantly influenced by the family environment of the depressed patient. In order to explore how family functioning relates to this illness, the authors examined changes in family functioning over a 1-year course of major depression. METHOD Subjective (Family Assessment Device) and objective (McMaster Clinical Rating Scale) assessments of family functioning were collected at hospitalization and 6 and 12 months after discharge for 45 inpatients diagnosed with major depression and their family members. Patterns of family functioning were examined by subjective and objective perspectives, initial levels of functioning, and reports of patients and other family members. RESULTS Approximately 50% of families with a depressed member perceived their own family functioning as unhealthy; clinicians rated 70% of the families as unhealthy. While family functioning improved significantly from hospitalization through 12 months after discharge, the improvement was not uniform across all areas of functioning. Further, patients with good family functioning at hospitalization generally maintained their healthy functioning and were more likely to recover by 12 months than patients with poor family functioning. Although steady improvement in family functioning characterized the subjective ratings, objective assessments of family functioning suggested initial improvement followed by a decline from month 6 to month 12. CONCLUSIONS Results show a clear association between family functioning and recovery from major depression. Different aspects of family life respond differently to the depressive illness; no one family dimension was uniquely related to outcome.

[1]  G. Keitner,et al.  Family functioning and major depression: an overview. , 1990, The American journal of psychiatry.

[2]  K. Davis,et al.  Age and the dexamethasone suppression test in depression. , 1984, The American journal of psychiatry.

[3]  I. Miller,et al.  The modified Hamilton rating scale for depression: Reliability and validity , 1985, Psychiatry Research.

[4]  G. Keitner,et al.  The Role of the Family in Major Depressive Illness , 1993 .

[5]  D. Kupfer,et al.  Analysis of time to stabilization in the treatment of depression: biological and clinical correlates. , 1987, Journal of affective disorders.

[6]  J. Leff,et al.  The Influence of Family and Social Factors on the Course of Psychiatric Illness , 1976, British Journal of Psychiatry.

[7]  M. Weissman,et al.  Factors associated with 1-year outcome of major depression in the community. , 1990, Archives of general psychiatry.

[8]  Sol Levin,et al.  The McMaster Model of Family Functioning. , 1978 .

[9]  A. Rush,et al.  Clinical predictors of recurrence in depression. , 1989, The American journal of psychiatry.

[10]  G. Keitner,et al.  The development of a clinical rating scale for the McMaster model of family functioning. , 1994, Family process.

[11]  J. Kane,et al.  The dexamethasone suppression test in depression. , 1983, Clinical neuropharmacology.

[12]  I. Glick,et al.  A controlled evaluation of inpatient family intervention. I. Preliminary results of the six-month follow-up. , 1985, Archives of general psychiatry.

[13]  K. Nuechterlein,et al.  Family factors and the course of bipolar affective disorder. , 1988, Archives of general psychiatry.

[14]  G. Klerman,et al.  The dexamethasone suppression test: An overview of its current status in psychiatry , 1987 .

[15]  H. Veiel,et al.  Psychosocial correlates of clinical depression after psychiatric in-patient treatment: methodological issues and baseline differences between recovered and non-recovered patients , 1992, Psychological Medicine.

[16]  G. Keitner,et al.  Family functioning and the course of major depression. , 1987, Comprehensive psychiatry.

[17]  M K Kaiser,et al.  MANOVA method for analyzing repeated measures designs: an extensive primer. , 1985, Psychological bulletin.

[18]  J. Teasdale,et al.  Predictors of relapse in unipolar depressives: expressed emotion, marital distress, and perceived criticism , 1989 .

[19]  L. Robins,et al.  National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. , 1981, Archives of general psychiatry.

[20]  G. Keitner,et al.  Depressed patients with dysfunctional families: description and course of illness. , 1992, Journal of abnormal psychology.

[21]  G. Keitner,et al.  Recovery and major depression: factors associated with twelve-month outcome. , 1992, The American journal of psychiatry.

[22]  H. Moss,et al.  Family management in the prevention of exacerbations of schizophrenia: a controlled study. , 1982, The New England journal of medicine.

[23]  Lawrence M. Baldwin,et al.  THE McMASTER FAMILY ASSESSMENT DEVICE , 1983 .

[24]  G. Keitner,et al.  THE McMASTER FAMILY ASSESSMENT DEVICE: RELIABILITY AND VALIDITY* , 1985 .