The burden of depression on significant others of depressed patients has not been explored fully to date. As a result there is little known about the psychological well-being of these primary support people who play an important role in the recovery and maintenance of well being of depressed patients. This thesis attempted to explore the burden of depression on significant others and test the effectiveness of a brief cognitive behavioural therapy intervention in improving the well being of this group. This was conducted over three studies.
Study 1 examined the burden of depression on significant others (DSO) and factors that moderate the impact of objective burden on subjective burden outcomes for DSO. In the first part of the study 158 participants consisting of 58 DSO of depressed patients (DP), 43 significant others of patients with Parkinson's Disease (PSO), and 57 significant others in a relationship where neither person had a physical or mental illness (CSO) were compared on measures of objective burden (Burden of Care Scale; Braithwwaite, 1990), depression anxiety and stress (DASS; Lovibond & Lovibond, 1995), general well being (GHQ; Goldberg & Williams, 1988) and relationship satisfaction (Dyadic Adjustment Scale; Spanier, 1976). Support was found for a significant burden of DP depression on DSO with comparable levels of objective burden, and symptomatology of depression and stress between DSO and PSO. There were inter group differences in reports of anxiety (PSO higher) and relationship satisfaction (DSO lower). The second part of the study examined whether the relationship between objective and subjective burden was moderated by DSO dysfunctional attitudes (DAS; Weissman & Beck, 1978); autonomous or sociotropic personality style (PSI-R; Robins., et al, 1994); coping styles (Cope; Carver, Scheier, & Weintraub, 1989); attributional style (ASQ; Peterson et al., 1982); or duration of the DP illness. The study was able to establish a moderating effect of dysfunctional attitudes, and autonomous personality style on the relationship between DSO objective burden and DSO depression. Higher levels of dysfunctional attitudes significantly and positively moderated the relationship between objective burden and depression with high levels of dysfunctional attitudes effecting higher rates of depression associated with objective burden. Low levels of autonomous personality style had a significant negative moderating effect on the relationship between objective burden and depression, with higher rates of depression associated with high burden in DSO. The study found no support for the moderating role of sociotropy, coping styles, attributional style, or duration of the illness. The study concluded that the burden of DP on DSO has been largely overlooked to date, and since DSO play an important role in providing support and facilitating the recovery of DP, future treatment of DP might consider adjunctive brief interventions for DSO.
Study 2 examined whether the 'contagion of depression' (Joiner & Katz, 1999) effect occurs in significant others (DSO) of patients with depression (DP). Levels fo depression were compared in 58 DSO, and 38 DP participants consisting of 58 DSO of depressed patients (DP) using the Depression Anxiety and Stress Scale (DASS; Lovibond & Lovibond, 1995); the Burden of Care Scale (Braithwaite, 1990); and the Zung Self rating Depression Scale (Zung SDS; Zung, 1965). No evidence of the contagion effect could be established in DSO. Two factors were considered as possible explanation of this finding: the protective role of familiarity in relationship - previously described in mood induction studies (Doerfler & Chaplin, 1985), and inferential limitations due to small sample size. The study also attempted to determine if the relationship between DSO objective and subjective burden was moderate by DP depression. The study found no support for the moderating role of DP depression consistent with a stress appraisal conceptualisation of burden.
Study 3 examined the effectiveness of a brief cognitive and interpersonal oriented psycho-educational treatment program for significant others (DSO) of depressed patients (DP). Treatment outcomes were measured in terms of improvements in reports of objective burden, depression, anxiety, stress, general well being, and relationship satisfaction from pre to follow up times. Results indicated there was a benefit in attending the treatment program for DSO in terms of a reduction in the perception of objective burden compared with the non-treatment group. No significant change between or within groups on repeated measures of depression anxiety and stress, general well being and relationship satisfaction was noted and suggested to be reflective of low scores on dependent measures at baseline. The results are discussed in the context of optimal modes of treatment delivery for this group.