Depression and dependency: distinct or overlapping constructs?

Dependent Personality in Depressed Older Adults: A Case Report and Systematic Review

Personality pathology in older adults is largely understudied. Here, we present a case report of an older adult who presented to an inpatient geriatric psychiatry unit with dependent personality traits in the context of chronic major depressive disorder, followed by a systematic review of the literature to identify research regarding the diagnosis and prevalence of dependent personality in depressed older adults. We identified 11 studies relevant to this topic. Synthesis of these data revealed that dependent personality is generally more common in depressed older adults compared to other personality disorders. However, studies were limited by small sample sizes and the use of assessments not validated for use in older adults. Therefore, it is difficult to draw conclusions from the available data. Potential implications for patient outcomes and health care services utilization are discussed. Our review highlights the need for larger scale research and personality assessments which are sensitive to age-related factors in order to draw evidence-based conclusions.

Development and Validation of a Six-Item Version of the Interpersonal Dependency Inventory

The Interpersonal Dependency Inventory (IDI) is a frequently used, 48-item measure of maladaptive dependency. Our goal was to develop and psychometrically evaluate a very brief version of the IDI. An exploratory factor analysis of the IDI in Study 1 ( N = 838) yielded a six-item IDI (IDI-6), with three items loading on an emotional dependency factor (IDI-6-ED), and the other three items loading on a functional dependency factor (IDI-6-FD). This factor solution was validated by confirmatory factor analysis in Study 2 ( N = 916). The IDI-6-ED and IDI-6-FD demonstrated good convergent and divergent validity in Study 3 ( N = 100). In Study 4 ( N = 22-43), the IDI-6-ED and IDI-6-FD were generally stable over 4-week and 8-week intervals and were found to be responsive to the effects of psychological treatment. These results have implications for dependency conceptualizations and support the IDI-6 as a brief, psychometrically sound instrument.

Absolute and relative short-term stability of interpersonal dependency in suicide attempters

Previous studies have reported an association between suicide and interpersonal dependency (IPD), but no study has examined whether IPD constitutes a state-dependent phenomenon or an enduring personality trait in this association. The aims of the present study were, firstly, to evaluate both the absolute and the relative stability of IPD as well as depression in suicide attempters and, secondly, to examine whether the relative stability of IPD was related to the depressive level rated on admission and/or at follow-up. The sample consisted of 41 suicide attempters evaluated on admission and 1 month later. The subjects filled in the Interpersonal Dependency Inventory (IDI) and the Beck Depression Inventory-II (BDI-II). The absolute and the relative stability of depression and IPD were analyzed using paired t-tests and Pearson's or intraclass correlation coefficients, respectively. The relative stability of IPD, taking into account the changes of the depressive level, was tested by two regression analyses. In the first regression analysis follow-up, the IDI scores were the dependent variable and the baseline IDI scores and BDI-II scores were the predictors. In the second regression analysis, the IDI change scores were the dependent variable and the BDI-II change scores were the predictors. Absolute and relative stability were demonstrated for IPD, whereas depression presented only relative stability. The IPD scores on admission were also significant predictors of the follow-up IPD scores after controlling for depression level. The 1-month duration of follow-up may be too brief to detect any decrease in the level of IPD. In conclusion, in contrast with the depression scores, the IPD scores presented short-term absolute and relative stability, and these results support the view that IPD is a stable personality trait in suicide attempters. The stability of IPD in suicide attempters suggests the interest of specific therapeutic approaches of this personality trait.

[Psychosocial problem disclosure during primary care consultations]

OBJECTIVE

To examine how primary care patients with psychosocial problems actually introduce and present these topics. To examine the influence of some personality traits (emotional dependency and health locus of control) on psychosocial problem disclosure.

DESIGN

"Case control". Cases had a GHQ-12 score equal or higher than three. Controls were matched with cases according to GP, GPs' attribution of absence or presence of emotional distress sex, age and presence of chronic illness.

SETTING

Six single handed primary care practices.

MEASURES

Clinical and Socio-demographic data, Social Problems List, List of 12 Threatening Life Events, GHQ-12, Multidimensional Health Locus of Control, Interpersonal Dependency Inventory and a Social Support Index.

RESULTS

The introduction of psychosocial topics by patients is related to the attribution of emotional distress by GP. Patients identified correctly as not distressed present less often psychosocial topics compared to patients recognised as distressed. Distressed patients not recognised as such more often than the others did not offer any psychosocial cue. The personality measures did not influence the presentation of psychosocial problems.

CONCLUSIONS

The lack of psycho-social cues from patients and of patient-centred skills contributed to the non recognition of emotional distressed patients. GPs' active facilitation of the presentation of psychosocial topics in such patients would improve the recognition of emotional distress.