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Several facets of perfectionism have been strongly associated with depression and anxiety. Dunkley and Blankstein (2000) combined these maladaptive traits with self-criticism to create a general construct labeled self-critical perfectionism. In this study, we employed confirmatory factor analysis to evaluate a model for assessing self-critical perfectionism in a clinically depressed sample using scales from 3 instruments. Participants were 356 depressed adult outpatients who completed 2 multidimensional measures of perfectionism and a measure of self-criticism. A confirmatory factor model that separated a self-critical perfectionism construct from a more adaptive, achievement-striving component of perfectionism was supported. A composite scale assessing self-critical perfectionism demonstrated much larger correlations with distress measures compared to a composite scale assessing achievement striving and also showed evidence of discriminant validity. In this study, we provided further support for the valid assessment of self-critical perfectionism and extended evidence for its assessment to a clinically depressed sample.

Investigations of the relationship between pain conditions and psychopathology have largely focused on depression and have been limited by the use of non-representative samples (e.g. clinical samples). The present study utilized data from the Midlife Development in the United States Survey (MIDUS) to investigate associations between three pain conditions and three common psychiatric disorders in a large sample (N = 3,032) representative of adults aged 25-74 in the United States population. MIDUS participants provided reports regarding medical conditions experienced over the past year including arthritis, migraine, and back pain. Participants also completed several diagnostic-specific measures from the Composite International Diagnostic Interview-Short Form [Int. J. Methods Psychiatr. Res. 7 (1998) 171], which was based on the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association 1987]. The diagnoses included were depression, panic attacks, and generalized anxiety disorder. Logistic regression analyses revealed significant positive associations between each pain condition and the psychiatric disorders (Odds Ratios ranged from 1.48 to 3.86). The majority of these associations remained statistically significant after adjusting for demographic variables, the other pain conditions, and other medical conditions. Given the emphasis on depression in the pain literature, it was noteworthy that the associations between the pain conditions and the anxiety disorders were generally larger than those between the pain conditions and depression. These findings add to a growing body of evidence indicating that anxiety disorders warrant further attention in relation to pain. The clinical and research implications of these findings are discussed.

Previous authors (e.g., B. R. Sarason, Shearin, Pierce, & Sarason, 1987) have found that perceived social support can affect the emotional well-being of an individual. Consequently, the effective assessment of social supports is a key issue in both research and clinical practice. The Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988) divides perceived social support into 3 distinct constructs-that derived from Family members, from Friends, and from Significant Others. This study is the first to assess the MSPSS using confirmatory factor analysis in both a college student (N = 549) and psychiatric outpatient (N = 156) sample. Based on several goodness-of-fit indicators, a 3-factor model for the MSPSS was supported in both samples, as was a single, higher order domain of Global social support. The perceived social support factors of Family and Friends consistently had the strongest associations with symptomatology. These results support the use of the MSPSS as a brief instrument for assessing the hierarchical structure of perceived social support in a variety of samples.

Both self-criticism and maladaptive dimensions of perfectionism have been associated with depression symptoms, based on cross-sectional and some longitudinal research with selective clinical and student samples. The present study evaluated a mediation model involving self-criticism, maladaptive dimensions of perfectionism, and depression-related symptoms at baseline (Time 1), and person-dependent stressful life events and depression-related symptoms 12 months later (Time 2), in a more representative noninstitutionalized sample. Participants included 723 community-based adults in an urban area. A proposed mediation model based on recent theoretical writings was evaluated, whereby the effects of self-criticism and maladaptive perfectionism on subsequent depression symptoms were hypothesized to be mediated by person-dependent stressful life events. In female respondents, the relationship between self-criticism and Time 2 depression was not mediated by person-dependent stressful life events and the relationship between socially prescribed perfectionism and Time 2 depression was fully mediated by person-dependent life events. In male respondents, self-criticism showed evidence of partial mediation while doubts about actions and socially prescribed perfectionism did not have significant main effects on Time 2 depression. Clinical and research implications of this important cognitive diathesis domain in association with person-dependent stressful life events and subsequent depression are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Background: Personality factors have been implicated in seasonal affective disorder (SAD). The present study investigated the relationship between the five-factor model of personality (neuroticism, extraversion, openness, agreeableness, conscientiousness) and SAD. Methods: Ninety-five patients with SAD completed personality measures before and after treatment in a clinical trial and during the summer months. The personality scores of the SAD patients were compared with a matched group of non-seasonal depressed patients and published normative data. Stability and change in personality scores with changes in mood state were assessed. Personality dimensions were evaluated as possible predictors of treatment outcome. Results: SAD patients showed elevated openness scores relative to both non-seasonal depressed patients and norms. Their neuroticism scores were lower than non-seasonal depressed patients, but higher than norms. All personality dimensions showed large and highly significant test–retest correlations but several personality dimensions, particularly neuroticism and extraversion, also showed considerable change with changing mood state. None of the personality dimensions were significantly associated with treatment outcome. Limitations: Personality assessment relied on self-report. Conclusions: The personality profile of SAD patients differs from both non-seasonal depressed patients and norms. Elevated openness scores appear to be a unique feature of patients with SAD. Since mood state has a significant impact on personality scores, assessment of personality in SAD patients should ideally be conducted when they are in remission. Further investigation of the relationship between personality and SAD, especially the potential significance of elevated openness scores, is warranted. [Copyright &y& Elsevier]

Objective: The present study evaluates the impact of a range of psychosocial factors on the outcome of major depression while controlling for the effect of clinical variables. Method: Patients (A2 = 171) seen in consultation at a mood disorders clinic completed measures of neuroticism, rumination, coping style, sexual abuse history, and parental bonding experiences at Time 1 and completed measures of interpersonal and achievement life events and depression 12 months later. Results: In univariate analyses, neuroticism, rumination, interpersonal and achievement life events, and sexual abuse history were associated with nonremission, whereas avoidance coping was associated with remission at Time 2. Interpersonal and achievement life events and sexual abuse history were associated with nonimprovement, whereas avoidance coping was associated with improvement at Time 2. Significant predictors of both remission and improvement in logistic regression analyses controlling for clinical variables (depression and anxiety severity, duration of illness, and age) included avoidance, interpersonal life events, and the interaction between avoidance and interpersonal life events. Conclusions: Interpersonal events and responses to depression (that is, coping) play an important role in the outcome of major depression. Further attention to coping style and interactions between psychological factors and life events is warranted in future research on depression persistence. [ABSTRACT FROM AUTHOR]

Background: Previous Canadian surveys have noted a wide range of prevalence rates for mental health service use and found no consistent relation between type of contact with mental health professionals and severity of illness. This study is the first investigation to examine the prevalence and correlates of mental health service use in a nationally representative Canadian survey. Methods: The Canadian Community Health Survey Cycle 1.1 was conducted between 2000 and 2001 (n = 125 493; respondent age 12 years and over; response rate; 84.7%). Respondents were asked whether they had contacted a professional because of emotional symptoms in the past year and about their experience of barriers to treatment. DSM-IV major depression and alcohol dependence diagnoses were assessed with the Composite International Diagnostic Interview Short Form. The relation between a range of measures of clinical severity and the type of professional contacted for emotional symptoms was examined. Results: The prevalence of 12-month help seeking for emotional symptoms was 8.3% (99%CI, 8.10 to 8.55); an additional 0.6% (99%CI, 0.49 to 0.62) of the sample perceived a need for treatment without seeking care. Respondents endorsing contact with multiple professionals or with psychiatrists only had higher levels of severity than those who had contact with family doctors only or nonphysician professionals only. Conclusions: Although untreated depression remains a significant problem in Canada, more severe illness was more likely to be associated with seeing a psychiatrist (or multiple professionals), indicating a relation between greater severity of mental illness and receiving more specialized care. [ABSTRACT FROM AUTHOR]

Using exploratory factor analysis, Bagby and Rector (1998) found evidence to suggest that the personality constructs of Neuroticism and self-criticism show enough overlap to be considered redundant with each other, while Agreeableness and dependency were found to be distinct from each other. The current study assessed the redundancy versus distinctiveness issue between these constructs through the use of confirmatory factor analysis with a sample of depressed patients (N=276) and a college student sample (N=281). Support was found for the separation of Neuroticism and self-criticism in both samples. Although a high degree of covariance was found between these two constructs, self-criticism can be conceptualized as being hierarchically nested in the higher-order domain of Neuroticism. Agreeableness and dependency were found to be distinct from each other. Our findings also supported Paunonen''s (1998) findings that lower-order individual difference variables have incremental predictive validity over higher-order personality traits, in this case with clinically-relevant criteria. Specifically, self-criticism accounted for a statistically significant additional amount of variance in measures of depression beyond that accounted for by Neuroticism in a clinical sample. [Copyright &y& Elsevier]

An emerging body of evidence has supported the distinction of adaptive and maladaptive subtypes of perfectionism. Although it has been hypothesized that developmental factors, particularly parenting experiences, play a role in the genesis of adaptive and maladaptive perfectionism, there is little empirical work available. Accordingly, the present study investigated the relationship among parenting experiences, adaptive and maladaptive perfectionism and depression proneness in a group of 261 college students. Structural equation modeling was used to evaluate a causal model in which harsh and perfectionistic parenting lead to maladaptive perfectionism which, in turn, leads to depression proneness. The model also included a path in which perfectionistic parenting leads to adaptive perfectionism which, in turn, has an inverse relationship with depression proneness. Fit statistics demonstrated superior fit of the hypothesized model compared to alternative models. There was evidence that maladaptive perfectionism mediates the relationship between harsh parenting and depression proneness. The results suggested that adaptive and maladaptive perfectionism have shared and unique developmental origins and that adaptive and maladaptive perfectionism have a differential relationship with depression proneness in adulthood. The results also suggest one mechanism by which harsh parenting may lead to vulnerability to depression. The findings support the validity of the adaptive/maladaptive dichotomy of perfectionism. [Copyright &y& Elsevier]

To date, there is a lack of evidence on the effectiveness of cognitive behaviour therapy for residual depression in naturalistic treatment settings. Previous reports have indicated that perfectionism and self-criticism may be predictive of poor response to individual cognitive behaviour therapy for acute depression. However, no studies of the impact of these cognitive variables on the outcome of treatment for residual depression have been reported. Accordingly, we sought to evaluate the effectiveness of a group cognitive behaviour therapy program for residual depression and to assess the impact of self-criticism, self-oriented perfectionism and socially prescribed perfectionism on the outcome of this treatment. Sixty-five patients (44 women) with residual symptoms (Beck Depression Inventory score >8) following medication treatment for major depression completed measures of depression, functional status, self-criticism, self-oriented perfectionism and socially prescribed perfectionism before and after 12 sessions of group cognitive behaviour therapy. Depression symptoms and functional status both showed significant change over the course of treatment (Cohen's d = 0.62 and 0.39, respectively). Pre-treatment self-criticism scores and change scores (pre- to post-treatment) for self-criticism and socially prescribed perfectionism were associated with the symptomatic and functional outcome of treatment. The results suggest that group cognitive behaviour therapy may be a useful and cost-effective treatment for residual depression in a tertiary care setting that uses predominantly prescriptive treatment. [ABSTRACT FROM AUTHOR]

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