Am J Psychiatry 1995; 152:1002-1008
Copyright © 1995 by American Psychiatric Association
Role of the family in recovery and major depression
GI Keitner, CE Ryan, IW Miller, R Kohn, DS Bishop and NB Epstein
Department of Psychiatry and Human Behavior, Brown University, Providence, R.I., USA.
OBJECTIVE: Major depression is significantly influenced by the family
environment of the depressed patient. In order to explore how family
functioning relates to this illness, the authors examined changes in family
functioning over a 1-year course of major depression. METHOD: Subjective
(Family Assessment Device) and objective (McMaster Clinical Rating Scale)
assessments of family functioning were collected at hospitalization and 6
and 12 months after discharge for 45 inpatients diagnosed with major
depression and their family members. Patterns of family functioning were
examined by subjective and objective perspectives, initial levels of
functioning, and reports of patients and other family members. RESULTS:
Approximately 50% of families with a depressed member perceived their own
family functioning as unhealthy; clinicians rated 70% of the families as
unhealthy. While family functioning improved significantly from
hospitalization through 12 months after discharge, the improvement was not
uniform across all areas of functioning. Further, patients with good family
functioning at hospitalization generally maintained their healthy
functioning and were more likely to recover by 12 months than patients with
poor family functioning. Although steady improvement in family functioning
characterized the subjective ratings, objective assessments of family
functioning suggested initial improvement followed by a decline from month
6 to month 12. CONCLUSIONS: Results show a clear association between family
functioning and recovery from major depression. Different aspects of family
life respond differently to the depressive illness; no one family dimension
was uniquely related to outcome.
