A diathesis-stress model conceptualization of depressive symptomatology

Abstract

Depression currently constitutes the most common mental illness observed in mental health services. In addition to its classical, psychiatric and phenomenological approach, a developmental, psychodynamic one has also been formed according to which there are two predisposing depressive types of vulnerability, the anaclitic and the introjective. These refer to the capacity of establishing reciprocal and mutually satisfying interpersonal relationships and to the formation of an integrated, mature and differentiated positive sense of identity, respectively. They are triggered when specific events, that match their sensitivity, occur. The personality-stress interaction with relation to depression has only scarcely been investigated so far in our country. Consequently, the purpose of the present study was to examine the relationship of the depressive vulnerability dimensions to depression. Our sample consisted of 714 subjects, 323 outpatient with depression and 391 healthy participants in the control group. They had an average age of 34.9 years and completed an improvised questionnaire on stressful events that referred to interpersonal and achievement issues, as well as the Depressive Experiences Questionnaire (DEQ), that assesses the dependent and self-critical vulnerability style, two personality constructs, focusing on issues of abandonment and self-worth. They were also administered the Beck Depression Inventory (BDI). Compared to healthy controls, patients with depression showed more severe depressive symptoms, scored higher in depressed types of vulnerability, and experienced more stressful events. Self-criticism was more strongly related to depression possibly because it represents a more articulated form of the disorder. The positive relation of self-criticism with both categories of adverse events pointed out that these vulnerable individuals are preoccupied with achievement topics and personal failures, but interpersonal quarrels and loss, as well. The hierarchical multiple regression analysis confirmed the participation of the diathesis-stress model in the prediction of depression and indicated that stress mediated the effect of personality on the depressive symptomatology. The naturalistic nature of the current study does not allow us to assign causal links between variables. Nevertheless, therapy may take into account the predominant personality type so as to design and deliver a treatment that matches the vulnerability.