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Background.- Interpersonal difficulties and stressful life events are important etiological factors in (recurrence of) depression. This study examines whether stressful life events mediate the influence of problems in nonverbal communication on recurrence of depression.Methods.- We registered nonverbal expressions of involvement from videotaped behavior of 101 remitted outpatients and their interviewers. During a 2-year follow-up, We assessed stressful life events and recurrence of depression.Results.- The less congruent the levels of nonverbal involvement behavior of participants and interviewers, the higher the incidence of stressful life events, and -via these - the risk of recurrence.Limitations.- Nonverbal behavior was measured in an experimental setting.Conclusions.- The results suggest that lack of nonverbal congruence during social interaction contributes to the occurrence of stressful life events, which in turn may trigger depression. (c) 2006 Elsevier B.V All rights reserved.

High neuroticism and low extraversion are related to depression and its recurrence. We investigated whether nonverbal involvement behavior during social interaction is one of the factors via which these relations are effectuated. We measured nonverbal expressions of involvement from videotaped behavior of remitted depressed outpatients (n =101) and their conversation partners, and assessed self-reported neuroticism and extraversion scores. During a 2-year follow-up, we assessed the recurrence of depression. Twenty-eight participants (27.7%) experienced a recurrent episode. Time to recurrence was predicted by neuroticism and extraversion, and also by the degree of association between levels of nonverbal involvement behavior of conversation partners. The behavioral effect did not explain the personality effect. Neuroticism moderated the behavioral effect. The results point to the independent relevance of personality and nonverbal behavior in the long-term course of depressive disorder. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

Background: The risk of recurrence in depressive disorder is high and increases with the number of episodes. We investigated whether individuals with a history of recurrent depression deviate from individuals with a single episode, as regards risk-related variables in 3 different domains of depression research.Methods: Participants were 102 outpatients with major depressive disorder remitted from an episode (60 recurrent, 42 nonrecurrent). We assessed the perception of emotions from vocal stimuli, 24-h urinary free cortisol, and neuroticism.Results: The recurrent group had higher cortisol levels than the nonrecurrent group, and recurrent women also had a more negative perception than nonrecurrent women. These results were independent of each other, and could also not be accounted for by neuroticism or residual symptoms. Gender differences were found in all 3 domains.Limitations: The cross-sectional design limits the possibility to draw conclusions on the causality of the observed effects.Conclusions: Remitted outpatients with recurrent depression deviate from remitted outpatients with single episode depression as regards physiology and social cognition, in a way that may increase their risk of the development of subsequent episodes. The results may have implications for prophylactic treatment strategies. (c) 2005 Elsevier B.V. All rights reserved.

The authors investigated the association of premorbidly-assessed disability and neuroticism with the onset of late-life depression in 86 depressed and 72 randomly selected control persons, originating front a 1993 Dutch community, study, of elderly, people, Compared with elderly people with average levels of disability, and neuroticism, people with low, levels were significantly less likely, to develop a depressive disorder High scorers, on the other hand, did not differ significantly,front the average group. Furthermore, the data tend to suggest that the increased risk for depression associated with disability was larger for patients with higher levels of neuroticism.

Background: A change in number and/or activity of natural killer cells has repeatedly been reported in depressive illness. Much less attention has yet been given to the subgroup of natural killer cells that are positive for the T-cell marker CD3 (NK–T cells). These cells possibly have important immunoregulatory properties. Methods: We compared number and percentage of NK–T cells (defined as CD3 + and CD16 + and/or CD56 + by two-color flow cytometry) in the peripheral blood of control subjects and two groups of elderly depressive subjects using or not using antidepressive drugs. Results: The number and percentage of NK–T cells were strongly elevated in elderly depressive subjects not using antidepressive drugs, as compared with control subjects and elderly depressive subjects using antidepressive drugs. Conclusions: Depressive illness in a geriatric population is associated with a substantial increase of NK–T cells. This increase was absent in a depressive group using antidepressive drugs.

Background: Coordination of nonverbal behaviour during interactions is a prerequisite for satisfactory relationships. Lack of coordination may form a risk factor for depression. The 'vulnerability-accumulation hypothesis' assumes that vulnerability to recurrence of depression will increase with increasing experience of depressive episodes. Therefore it is expected that interviewers and patients remitted from a recurrent episode of depression would reach less coordination during a clinical interview compared to interviewers and patients remitted from a first Lifetime episode. Moreover, we assumed that prior severity of depression modifies this reciprocal coordination process. Methods: During discharge interviews, interviewers were videotaped in interaction with remitted patients with unipolar major depression recurrent depression (REC); n = 28; first episode (SEP); n = 22. Durations and frequencies of nonverbal involvement behaviour was registered during the first 15 min. Involvement of the patients consisted of gesticulating, looking at the interviewer, and general head movements; yes nodding and hm, hm, yes, yes reflected involvement of the interviewer. Coordination between patients and interviewers was analyzed per S-min epochs and defined as 'attunement': the absolute difference between patients' and interviewers' involvement. Averaged attunement, its time course and variability (presumably reflecting control of the attunement process) were assessed. Results: The time course of nonverbal attunement differed between the REC and SEP condition. A larger variability of attunement was found in patients remitted from a relatively severely depressed episode, compared to patients remitted from a seven first life time episode. No other significant differences were found. Conclusions: Partial support was found for the notion that nonverbal vulnerability accumulates in depression and that the severity of prior depression modifies this process. (C) 2000 Elsevier Science B.V. All rights reserved.

Excessive support seeking and lack of receiving social support have been associated with depression onset and unfavorable course of depression. It has been assumed that social support is effected by observable behaviors that express involvement. Twenty-five patients with major depression were studied during a social interaction with their partner and a similar interaction, with a stranger, matched on the sex and age of the partner. We anticipated that (1) partners would display less involvement behaviors to the depressed patients than would strangers and that (2) lack of involvement would predict an unfavorable course of depression, as assessed for depression remission within 6 months of admission. The social interactions, conducted at admission, were videotaped and the behaviors were assessed by ethological methods. The frequency and duration of behavioral elements were associated on the basis of statistical criteria into behavioral factors. Certain factors were supposed to express (lack of) involvement during an interaction. In the patient-partner interaction it was found that both participants displayed lower levels of involvement as compared to the patient-stranger interaction. The patients' low involvement was reflected by less Speech, less Eagerness (yes-nodding and no-shaking), less Speaking Effort (head movements, looking and gesturing during speech) and more Active Listening (intense touching of one's own body and head movements during listening). The partners' low involvement was also expressed by less Speech and more Active Listening, together with less Encouragement (yes-nodding and 'um-hum'-ing during listening). In addition, the partners displayed less Speech to patients who did not remit within 6 months, whereas patients and strangers behaviors were not related to depression remission. These findings supported our anticipations and the findings are related back to data on social support, involvement and to previous human ethological studies on depression.

The administration of light at the development of the first signs of a winter depression appears to prevent it from developing into a full-blown depression. Not a single patient from a group of 16 treated this way became severely depressed during the remaining part of the winter season, whereas 5 out of 11 from the non-treated control group did.

Observed behaviour of a psychiatrist interacting with severely depressed patients during an interview was related to the course of depression during hospitalization. The behavioural structure of such interaction could be described by 6 factors for the patients and 7 factors for the psychiatrist. The study focuses on the psychiatrist's behaviour.The severity of depression and the level of the behaviour factors were assessed just after admission (drug-free) and 10 weeks later. Patients were divided a posteriori into non-improved patients (N = 13) and improved patients (N = 18). The psychiatrist displayed low levels of 'active-listening' (intensive body touching and other hand movements during listening) and showed a tendency to more 'encouragement' by use of remarks such as hm, yes, and head-nodding) in his interaction with patients who did not improve. These factors did not change over time, suggesting that they may play a role in the maintenance of depression. They are supposed to express involvement, and probably indicate psychiatrist's giving support to the support-seeking patients. At the same time the psychiatrist exhibited an aversive response to the non-improved patients, by showing higher frequencies of looking away during his encouragement. The results provide support for interactional theories on depression and illustrate the possible value of an ethological approach in the study of interactional processes.

This study examined whether the interaction of severely depressed patients and a psychiatrist was related to the course of depression during hospitalization. Interactional processes were defined on the basis of directly observed behaviour displayed during an interview and by the use of ethological methods. The behavioural structure of the interaction could be described by five factors. The severity of depression and the level of the behaviour factors were assessed just after admission (at baseline) and 10 weeks later. Patients were divided a posteriori into non-improved patients (N = 13) and improved patients (N = 18). Patients who did not improve displayed more 'speaking-effort' (looking, gesticulating, head movements during speech) and less 'active-listening' (head movements and intensive body touching during listening to the psychiatrist) than those who did improve. These factors increased over time in the improved patients but not in the non-improved patients suggesting that they may play a role in the maintenance of depression. The study illustrates the possible value of an ethological approach in the study of interactional processes.

The interaction of 61 severely depressed hospitalized patients and a psychiatrist was studied during a clinical interview. Interactional processes were defined by the use of ethological methods. Various observed behaviors were clustered on the basis of statistical criteria, yielding behavior factors of the patients and of the psychiatrist. The present paper deals with the organization of the psychiatrist's behavior and the interrelatedness of the patients' and the psychiatrist's behavior.Analysis of the behavior of the psychiatrist revealed seven factors: restlessness-1 (head, leg movements, object touching), restlessness-2 (body touching, head movements), speech (speech, gesticulating, yes and no movements), active listening (intensive body touching and hand movements), turn-taking (leg movements and gesticulating during listening), encouragement (back-channel behavior and yes-nodding), and change-looking (looking and head movements). Within the constraints of studying interactions which are bidirectional, it was found that restlessness-2, speech, encouragement and active listening of the psychiatrist could be 'predicted' from observed behavior of the patients (multiple regression model). The psychiatrist's behavior was related both to the severity of depression and to observed behavior not directly associated with severity. The psychiatrist's behavior was more strongly related to that of the more severely depressed patients than to that of the less severely depressed patients. These results contribute to an understanding of the behaviors displayed and elicited by depressed patients during a first encounter with a stranger.

Twenty-three patients with a major depressive disorder were deprived of a night's sleep twice weekly, one week staying up in the dimly lit living room of the ward (less than 60 lux), and one week in a brightly lit room (greater than 2000 lux). Immediate, but transient beneficial effects of sleep deprivation were observed primarily in eight patients (the 'responders'). The immediate effects did not differ greatly for the two conditions, indicating that exposure to light at night is an implausible explanation for the antidepressant effects of total sleep deprivation. There was some evidence that the bright light condition led to a more prolonged improvement of the responders.

Total sleep deprivation (TSD) in depressive patients is known to produce sudden changes in mood, but the factors involved in these mood changes are poorly understood. In this study the role of psychomotor activation was investigated by examining the relationships between baseline measures of activation and subsequent clinical response to TSD. Two methods were used to assess the degree of activation: global judgment (clinical ratings) and direct observation and registration of behavior (ethological methods). Behavioral and global assessments took place 1 day before TSD during a medication-free psychiatric interview. The amount of looking displayed during the interview was negatively correlated with the subsequent clinical response to TSD, while body-and object-touching hand movements showed a positive correlation. During switches from speaking turn and at the start of the patients' speaking turn, responders to TSD showed more hand movements than nonresponders. No relation was found between clinical ratings of the degree of psychomotor activation and the TSD response. Our data suggest that the clinical response to TSD may be predicted and therefore possibly mediated by dimensions of activation. For the detection of these dimensions, behavioral observation appears to be more suitable than global clinical judgment.

This study deals with the question whether the often reported sleep loss in animals with lesions in the rostral midbrain raphe system (the dorsal and medial raphe nuclei) might be explained by the hyperactivity shown by the animals when confronted with unfamiliar environments. Rats with electrolytic raphe lesions were compared with sham-operated rats as to both sleep and activity parameters under 3 conditions differing in familiarity. In spite of a reduction of forebrain serotonin and 5-hydroxy-indoleacetic acid of about 60–70%, raphe-lesioned rats could not be distinguished from sham-operated rats as tosleep parameters such as slow-wave sleep and REM sleep under different conditions. Thus, structural integrity of serotonin-containing neurons was not found to be a necessary condition for the normal production of sleep in rats. Locomotor activity, however, was significantly increased in raphe-lesioned rats, but this increase showed no relationship with sleep production.