Academic journal article Journal of Marital and Family Therapy

Affective Disorders

Academic journal article Journal of Marital and Family Therapy

Affective Disorders

Article excerpt

Unipolar depressive disorders are especially common among persons presenting with marital and family problems, rendering their impact on the treatment of marital and family problems of interest to every marriage and family therapist. The current paper describes empirically based decision making rules for determining who may benefit most from marital and family therapy interventions. Using well-controlled outcome research, it is concluded that both marital therapy and parenting interventions can play an important role in the treatment of many but not all depressed persons. Predictors of treatment response are discussed and recent epidemiological research is used to examine the size of the population that may respond especially well to marital therapy. Future directions for research are suggested and public policy implications are discussed.

The unipolar depressive disorders are among the most prevalent of Axis I disorders in adulthood and they are especially common among those with marital and family problems. Therefore, persons with difficulties in both areas simultaneously are likely to be encountered by every couple and family therapist. Because marital and family interventions may help relieve the symptoms of depression and the interpersonal problems so commonly associated with depression, it is appropriate to examine the potential public policy implications of recent progress in this area. However, for the public to benefit maximally from wider availability of marital and family interventions for depression, it is critical that marital and family therapists develop sound clinical decision-making rules regarding which depressed persons are most likely to respond positively to marital and family therapy. The current review begins with a description of depression that recognizes its heterogeneity, its connection to marital and family problems, and its response to empirically supported marital and family therapy approaches. Public policy implications are underscored and guidelines for clinical decision making are suggested. I conclude with a brief discussion of potential future directions for research and a listing of Internet resources that may be useful to graduate students or others seeking information about funding for research or clinical tools.

In an earlier review of this topic, Prince and Jacobson (1995) concluded that, "marital therapy may be helpful when applied to outpatient depressed clients" (p. 388). The authors suggested that other forms of family therapy had been insufficiently evaluated to draw strong conclusions regarding their potential efficacy in the treatment of adult unipolar depression. Three additional studies of marital therapy for depression and two studies of parenting interventions for depression have appeared since that review. Accordingly, the database establishing that marital and parenting interventions may be potentially efficacious in the treatment of depression is stronger, albeit modestly so, than it was in 1995. As was true in 1995, other forms of family therapy have been insufficiently studied to draw conclusions regarding potential efficacy. At the same time, considerable progress has been made in providing a sound empirical foundation for public policy. This is due primarily to improved epidemiological evidence regarding the prevalence of marital discord among depressed persons and the temporal precedence of marital discord relative to the onset of depression. Accordingly, it is now possible to suggest that marital therapy and perhaps parent training are necessary and medically prudent in many cases of adult unipolar depression, and that these interventions should be more widely available than they are currently.

INTRODUCTION TO THE PSYCHOPATHOLOGY OF DEPRESSION

What exactly is depression? Answering this deceptively simple question in detail could easily take up the entire chapter. On the other hand, providing no discussion of the psychopathology of depression leads to an overly simplistic view of depression that can hinder the work of researchers and practitioners alike. …

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