Depressive Behaviors and Interpersonal Rejection:
How Depression Can Sustain Itself
At any given time in the United States, between 4% and 10% of the population is experiencing depression, and recent research indicates that an alarming trend may be occurring. For people in their 70s, there is a 2% chance that they have experienced depression during their lifetime. For those in their 50s, that chance increases to 5%. Although they have lived fewer years, the likelihood that they have experienced depression is more than double. The same pattern continues as younger and younger groups are examined. For those in their 30s, the risk is 8% and, for teenagers, it is 12%. Even though teens have lived four times fewer years than those in their 70s, their chance of having experienced depression in their lives thus far is six times greater! If this trend continues, what will the rates be when these teenagers are elderly?
Chronic depression can be a debilitating condition. The burden on those who have it and on society is clear. From lost work hours to increased use of health care services, the financial cost is high. Most concerning, however, is that depression can lead to suicide. Research has indicated that approximately 70% of young adults who had recently attempted suicide had a mood disorder. When compared with the general population, depressed people’s risk of death by suicide is 30 times higher. Among adolescents, suicide is the third leading cause of death, accounting for 14% of total deaths in this age group, and the overall suicide rate among adolescents has increased more than 300% in the past 50 years.
All this would be bad enough even if depression were a one-time event; however, depression is extraordinarily persistent and recurrent. The average length of a major depressive episode is approximately eight months in adults and nine months in children. Additionally, studies have found that 70% of people who have experienced a depressive episode subsequently experienced at least one more.
How can we account for the chronicity of depression? Why is it so unrelenting once someone becomes depressed? Several theorists have argued that depressive symptoms have a way of sustaining themselves. From this perspective, it is as if depression “feeds off of itself.” One way this might happen is through poor interpersonal behaviors. It is well documented that depressed persons are often rejected by people in their environment. This can work to maintain the depression and lead to more depressive symptoms. But what exactly do they do that causes others to reject them?
Family Interactions
There is an abundance of evidence that chronic depression causes problems within the family and the subsequent rejection of the depressed person. Depression and marital distress are common. The negative mood and irritability of the depressed person often leads to communication with the spouse being harsh in tone and often involves cycles of negative interactions and hostility.
Depressed people often engage in excessive reassurance seeking, defined as persistently seeking assurances from others that one is lovable and worthy even when these assurances have already been provided. It is important to note that the use of the term excessive reassurance seeking is to distinguish between healthy seeking of support and the repeated seeking of support when it has already been provided.
Initially, the depressed person’s expressions of hopelessness and the need to be reassured tend to evoke quick and sympathetic responses from others. However, this is not enough as the depressed person is also seeking information regarding the nature of the interpersonal relationship and his or her place in it. In other words, the depressed person is asking a central question: Am I okay within this relationship? The continued seeking of reassurance after it has been given multiple times becomes aversive for the partner, who typically responds with hostility. The partner may then feel guilty, because the depressed person is truly suffering, but this guilt just leads to anger and more hostility.
In addition to difficulties with their spouses, depressed persons experience as many problems in their role as a parent as they do in their role as a partner. The children of depressed parents are at a much higher risk for behavioral and emotional problems than are those of non-depressed parents. These children frequently display rejecting behavior toward the depressed parent during interactions including negative mood, irritability, and a failure to look at the parent while conversing.
Social Skills Deficits
Depressed individuals experience problems outside the family as well, and they are often the recipients of negative reactions from those in their social environments. This may be due to poor social skills that make it unpleasant to be around them. Although there are a number of things depressed people do that others find frustrating, two that research shows consistently leads others to evaluate them negatively are they tend to burden others with their problems, and they fail to be responsive to others during conversations.
Most people with good social skills try not to impose upon or burden others. When asked how they are doing, many people will respond "just fine," when in fact they are not. Unless they are speaking with a close friend who truly wants to know, a response of "terrible" or "not so good" places a burden on the other person to ask about the reason for this unfortunate situation. Often, this may not be appropriate such as when passing in the hall or in a group of strangers. Additionally, depressed people not only express negative well-being, mood, and self-evaluation, but they also tend to make repeated demands on their family and friends for help. Expressing negativity, hostility, and frequently demanding help can result in people feeling imposed upon and obligated to offer assistance or find out the cause of the depression. This feeling of obligation is often experienced as unpleasant and may cause the family member or friend to turn away from and reject the depressed person.
A second social expectation that depressed people often fail to meet is appropriate responsiveness to others during conversations. A lack of responsiveness causes conversations to break down and become rather monotonous and aversive for those involved. Depressed people tend to display low responsiveness by looking down or away when speaking, speaking at a low rate and volume, and lacking liveliness. This behavior communicates the message, “You are not important” to the people they interact with, and those people tend to experience the interaction as disagreeable. Substantial evidence shows that people are attracted to those who are highly responsive to their communication. Alternatively, those who are not responsive to their interpersonal partner run a high risk of eliciting disinterest and rejection from that person.
Self-Management and Depression
Depression mars the lives of millions—those who have the disorder as well as those close to them. However, there are treatment options for those suffering with depression. One proven effective treatment of depression, chronic or otherwise, is anti-depressant medication. Anti-depressant medications have gained popularity during the past 50 years as a method of intervention for depression. Most have a high success rate of relieving acute depressive symptoms, and studies indicate that they significantly reduce symptoms for approximately 65% of those who complete treatment.
Although they have a high rate of success for acute symptoms, medications do not address the social skills deficits commonly found in chronically depressed individuals that lead to interpersonal problems. However, there are psychosocial treatments designed specifically for this purpose. For example, the cognitive-behavioral analysis system of psychotherapy (CBASP) is a cognitive-behavioral approach to treating chronic depression. The CBASP method teaches chronically depressed individuals self-management skills through examining interpersonal encounters. Chronically depressed people typically do not learn from problematic interpersonal encounters and modify their behaviors accordingly. CBASP uses cognitive, behavioral, and interpersonal techniques to teach the depressed person to focus on the consequences of behavior and use a problem-solving approach to resolve interpersonal difficulties. With the help of the therapist, the patient compares actual outcomes with what he or she wished had happened. Then, they generate ideas regarding what the depressed person could have said or done differently to produce the desired outcome. These ideas can be tested in future interpersonal interactions. With practice and experience, depressed persons learn to be self-aware by monitoring their own behavior and anticipating its consequences. They also become sensitive to how their behavior affects those around them. These are important components of successful self-management and, by using these skills, depressed individuals can learn healthy interpersonal behaviors that may help prevent future depressive episodes.