Title: Interpersonal Distress and Interpersonal Problems Associated with Depression
Description: A relationship between interpersonal functioning and depression has been suggested by theorists and empirical studies. However, there are a limited number of studies focusing specifically on the association between depression, interpersonal distress, and interpersonal problems as assessed by the Inventory of Interpersonal Problems-32 (IIP-32). The present study investigates under-explored or overlooked aspects of the literature that outline this relationship. Initially, the study set out to examine interpersonal markers of depression in a sample of 170 individuals seeking psychoanalytic or psychodynamic treatment. A unique aspect of this study is that the examination of depression involved categorizing individuals as depressed based on either categorical Structured Clinical Interview for DSM-IV Disorders (SCID) or severity measures Hamilton Rating Scale for Depression (HRSD) and Quick Inventory of Depressive Symptamotology (QIDS). A correlation was found between depression severity (assessed by the HRSD and QIDS) and overall interpersonal distress and 6 of the 8 interpersonal problems.

We further demonstrated that irrespective of the measure used to define depression, depressed individuals had greater overall interpersonal distress than non-depressed individuals. Depressed individuals also had significantly higher scores on several of the IIP subscales (too aggressive, too dependent, too caring, hard to be sociable, hard to be involved, and hard to be assertive). The gender analyses suggested that men had significantly more interpersonal distress than women and that men and women had significantly different scores on the hard to be supportive and hard to be involved subscales (scores were higher for men) as well as the too aggressive sub scale (scores were higher for women). Across our initial analyses we found that interpersonal distress also differed based on PD severity. Although both depression and PD severity were significantly associated with interpersonal distress, these independent variables did not interact. We attributed this to comorbidity between depression and Axis II pathology, correlation between measures and the fact that each variable had several levels.

We therefore conducted secondary analyses by subdividing and recategorizing the sample into new groups based on both depression and Axis II diagnoses. Results revealed that individuals who were diagnosed with both depression and at least one PD had the greatest amount of interpersonal distress relative to those with one or neither of the disorders (depression or PD). When focusing on depression, gender, and interpersonal functioning, results indicated an absence of gender differences. Men and women with a comorbid personality disorder did not differ in interpersonal distress and had significantly greater interpersonal impairment than men or women who were solely depressed. Furthermore, solely depressed men and women did not differ in interpersonal distress. In terms of the subscale analyses the depressed group with comorbid Axis II pathology had greater distress related to a number of interpersonal problems: hard to be sociable, hard to be assertive, too aggressive, too dependent, hard to be involved, and too caring.

There were several further group differences that were particularly salient. Depressed and non-depressed individuals (free of Axis II pathology) did not differ on any of the IIP subscales. However, the exclusively depressed group differed from the depressed group with PD on four subscales (hard to be sociable, hard to be assertive, too aggressive, and too dependent). Focusing solely on Axis II pathology, in the absence of depression, individuals with a PD and no depression had significantly more distress than individuals with no PD and no depression on several subscales (hard to be sociable, hard to be involved, too dependent, and hard to be assertive). Moreover, on these subscales, we saw that this PD group behaved similarly to the comorbid group (i.e. depressed with PD) as both differed from the healthiest group (i.e. non-clinically depressed without PD). However, the comorbid group had higher mean scores. These findings suggest that depression may not be associated with a pattern of interpersonal distress, however Axis II pathology might be.

Although there is variability in group differences, what is consistent is that the comorbid group had greater interpersonal distress. For individuals who are depressed, the presence of Axis II pathology seems to increase the severity of interpersonal problems. Results from the analyses of the subscales comparing men and women provide further evidence that interpersonal functioning is most problematic in the context of comorbidity. A consistent finding when examining the group of depressed men is that men with PD had significantly greater interpersonal distress on all of the subscales related to social interaction and connection (i.e. hard to be involved, hard to be supportive, hard to be sociable, and hard to be assertive). Women with PD had significantly greater interpersonal distress related to being too aggressive than depressed men with PD. Furthermore, both depressed men and depressed women with PD had significantly greater distress than depressed women without PD on the too dependent subscale.

In addition, the current study also found that individuals who over-reported their depressive severity relative to the clinician (defined as a higher score on the QIDS than on the HRSD) had significantly greater odds of having a Cluster B personality disorder, moderate interpersonal distress, and moderate or severe anxiety. In summary, the initial difference between depressed and non-depressed individuals and depressed men and women in terms of overall and specific interpersonal distress became more nuanced when Axis II pathology was considered. Results consistently suggest that interpersonal distress is most exacerbated by comorbidity. The study concludes with a discussion of study limitations and directions for future research.