The influence of an uncaring partner on the type and outcome of depression

Background: We seek to clarify recent inconsistent research findings in relation to the Intimate Bond Measure (IBM), where low IBM care scores have been held to be over-represented in non-melancholic depression and to predict a poor depressive episode outcome. Methods: A sample of 82 subjects meeting DSM criteria for a major depressive episode lasting less than 2 years, took part in a 1-year follow-up study. The IBM was completed at initial assessment and depression severity assessed at baseline and at follow-up assessment, allowing a measure of ‘outcome’. Results: A significantly greater proportion of DSM-defined non-melancholic than melancholic depressives perceived their partner as providing deficient care and were classified as being in a dysfunctional relationship, seemingly unrelated to demographic differences or by depression severity, chronicity or recurrence. IBM scores were again established as independent of a number of putative distorting influences, such as depression severity and ‘neuroticism’. Although the IBM failed to significantly predict outcome, there was a clear trend for greater improvement in those in IBM care score-defined ‘functional relationships’. Limitations: The study failed to assess the change in patients’ perceptions of care over time, which may have contributed to the failure to replicate past findings in relation to outcome. Conclusions: The significance of examining the relevance of psychosocial factors such as deficient intimacy to separate depressive sub-types is highlighted. Implications of these findings for clinical intervention and future research studies are discussed.