Mothers coping with risk (1990-5)

Since depression is recognised to be higher not only in women, but also in those who are mothers, this study aimed to investigate the mechanisms by which depression was triggered according to the vulnerability-provoking agent model. Only high-risk mothers with no depression at first contact were selected, to examine their coping and crisis support with stressful experience over a year in relation to new onsets of depression. All the mothers were selected for having inter-personal problems (conflict with partner or child, or lack of a close support figure) or low self-esteem. These were the vulnerability factors for onset of depression discovered in a similar but representative study of mothers conducted in the 1980s in the same area of London The high risk women were studied over a 15-month period, during which there were three interview contacts at first point, then at five and ten months.

Aim

The aim of this study was to replicate previous findings and confirming the vulnerability factors for onset of depression. However, it served to add to previous findings by charting in finer detail and at closer range, their coping with stressful events over a 15-month period. This would enable an analysis of risk and resilience in mothers selected for having difficulties in their relationships. Lifetime risk factors were also investigated in order to see the trajectories by which the women had become vulnerable in adult life.

The sample

Screening for participants was again conducted through local general practice registers, where 3,000 questionnaires were sent out to women aged between 18 and 50 eliciting a 45% response rate. From those who replied only working-class mothers or single mothers were selected, constituting half of the questionnaire replies. Of the remainder it was necessary to de-select those already depressed at either major or minor level (a quarter of the remaining responses) and those with clearly low scores on a screening questionnaire assessing poor inter-personal relationships (a further quarter). A telephone screening was then conducted on the remaining responders. Of these 72 per cent were verified as being suitable for the project in terms of being free from depression and also having the adult vulnerability factors (of negative interaction with partner or child and lack of a close confidant). Initially 110 women were interviewed with 105 women who agreed to complete all three interviews.

Measures used

Prospective measures

• Life Events and Difficulties Schedule
• Coping and crisis support
• Self-esteem; negative elements in close relationships
• Parenting; partner relationship and external arena
• Attachment Style Interview
• SCID for recent onset of depression and anxiety

Retrospective measures

• Childhood Experience of Care and Abuse
• Adult Life Phase Interview
• SCID for lifetime disorder

Findings

Over a third (37%) of women became depressed in the follow-up year which was nearly four times the usual rate as found in earlier representative series (10%). Most of the women (72%) experienced a severe life event in the follow-up period. For this group the depression rate was 47% . A replication of the earlier vulnerability-life event model was confirmed.

Two factors proved to be associated with a lower risk of depression even among such vulnerable women. One was a rating of 'good ability to make and maintain relationships' at first interview, a basis of secure attachment style, and the second was good coping conferred by high mastery, optimism or downplaying at the time of the severe event. Both had the effect of halving risk.

Insecure attachment style was confirmed as an additional vulnerability factor for onset of depression. Those women with highly Enmeshed, Fearful or Angry-dismissive styles of attachment had double the rate of depression of the remaining women.

Over half of the women (57%) had experienced severe childhood neglect or abuse, more than double the rate expected in a representative series of London mothers. Thus even though they were selected for having troubled relationships in adult life, this series were more likely to have suffered these in childhood also. Adult adversity proved a link between such childhood experience and ongoing difficulties and disorder. Both childhood adversity and adult adversity contributed to models of chronic or repeated depression.