A profile of neuropsychological deficits of clinically depressed (major depression) but otherwise unimpaired individuals is presented, based on a meta-analysis of all studies published since 1975 and meeting stringent methodological and sample selection criteria. Deficits are discussed separately for different cognitive areas in terms of mean size of deficit, variability between studies, variability of individual scores in depressed populations relative to that of controls, and expected proportion of depressed individuals scoring two standard deviations or more below the mean of controls. The neuropsychological deficits of individuals with major depression are shown to be consistent with a global-diffuse impairment of brain functions with particular involvement of the frontal lobes. Recent neuro-imaging studies also indicating frontal dysfunction in clinical (functional) depression are referred to. Both the severity and the profile of cognitive deficiencies in depression are postulated to be similar to those seen in moderately severe traumatic brain injury.

No abstract

Formulas for premorbid intelligence estimates are typically derived by linear regression and are therefore biased in individual cases because of regression to the mean. It is shown that it is inappropriate to compare such IQ estimates with current IQ scores to determine whether a decline from premorbid levels has occurred. This widespread practice grossly overestimates the probability of an IQ decline in the below-average range and grossly underestimates it in the above-average range, with serious implications for clinical practice. The authors present a formula for computing unbiased estimates of IQ decline as well as a test of the null hypothesis of no decline. Corresponding tables for several combinations of test indices and estimation methods are included for practical reference.

The social support patterns of a sample of 101 suicide attempters were compared with the patterns of a control sample on the basis of structured interview data. Network characteristics and the extent of support in different functional categories were examined as to their absolute and relative power to discriminate between the suicide attempters and the controls. A clear separation of the functions of kin and of friends/acquaintances emerged. The crucial difference between the attempters and the controls lay in the number of friends with whom the subjects had agreeable everyday interactions and in the number of kin that provided crisis support, both psychological and instrumental. Other support differences between the two groups were of secondary importance. While there was no overall difference in the frequency of social interactions between the two groups, the size of the social network differed greatly. Consequences for the conceptualization and measurement of social support as well as for the prevention of suicidal behavior are discussed.

SYNOPSISGeneral methodological and design issues in research on psychosocial outcome predictors of clinical depression are discussed, and the first stage of a study of discharged depressed in-patients is presented. It involved 115 recovered and 75 non-recovered such patients who were compared regarding stress factors, social support, personality and coping styles. While there were few differences between recovered and non-recovered patients with respect to stable personality traits, recovered patients were less likely to have had severe long-term life difficulties, and their coping style differed: it was characterized by more negative appraisals of stressful situations, greater problem avoidance, less palliative activities, and a lesser inclination to solicit social support. Whereas among women without partners, as well as men, non-recovery was also associated with less support from friends, in particular psychological-emotional support in crises, non-recovered women with partners had much more such support. The results are discussed with reference to the existing literature on outcome correlates of clinical depression.