Stress, coping, uplifts, and quality of life in subtypes of depression: a conceptual frame and emerging data

Background: Depressive illness is associated with several functional disturbances, including increased stress perception and reliance on emotion focused coping styles, reduced perception of uplifting events, and impairment of several aspects of quality of life. Inasmuch as different subtypes of depression may be accompanied by differing neuroendocrine profiles, it was of interest to establish whether they could also be distinguished from one another on the basis of functional behavioral indices. Methods: Major stressors, day-to-day stressors and uplift perception, coping styles, and quality of life were assessed in control participants, as well as in acute or chronically (dysthytnia) depressed patients exhibiting either typical or atypical features, and in treatment resistant major depressive patients. Results: Relative to controls, the depressive groups had higher perceptions of day-to-day stressors (hassles), reduced perception of uplifting events, excessive reliance on emotion-focused coping strategies, and diminished quality of life. Among depressed patients the hassles, coping styles and some elements of quality of life were related to symptom severity, as well as treatment-resistance. Limitations: Data concerning stress, coping and quality of life were collected retrospectively, and the number of subjects in each condition was small. Hence, the relationship of the outcome measures to depression need to be considered cautiously. Conclusions: Quality of life represents a functional index of the behavioral and cognitive impact of depression. This outcome measure is sensitive to differences as a function of depressive characteristics, and may prove to be a useful assessment tool in evaluating treatment efficacy. (C) 2002 Elsevier Science B.V. All rights reserved.