Making sense of melancholy: Sub-categorisation and the perceived risk of future depression

Abstract

This paper investigates the relationship between an individual's experience of depression and her conceptualisation of its role in her life and sense of identity. Based on a mixed methods study involving interviews with 37 women diagnosed with unipolar or bipolar depression, the findings indicate that women who considered most of their episodes to have been triggered by events or circumstances in their lives were more likely to believe that their depression could in future be overcome, whereas those who did not consider the majority of their episodes to have been triggered were more likely to believe their depression to be chronic. Thus, women who participated in the study perceived the risk that they might never be able to overcome depression differently according to whether they believed most of their depressive episodes could be categorised as having been triggered or not. The reasons behind their beliefs are explored. Implications for the traditional medical exogenous–endogenous (reactive–endogenous) distinction are discussed.

Keywords:

• depression
• risk perception
• relapse
• triggers
• control

Acknowledgements

We wish to sincerely thank all the participants who so generously shared their time and experiences for this study, without whom it would not have been possible. We also wish to thank the editors, Professor Bob Heyman and Dr Patrick Brown for their constructive feedback, and Professor Emeritus Martin Richards, Dr Ilina Singh and the two anonymous referees for their helpful comments.

Notes

1. As we aimed to cover different types of depression in the sample, women diagnosed with bipolar depression were included. Because these women experience ‘manic’ episodes, and some felt that such episodes had been triggered by their life experiences, it made sense to do so.

2. The Beck Depression Inventory is one of the most frequently used methods for measuring the severity of depression. It consists of 21 multiple-choice questions which ask about feelings of hopelessness, guilt, irritability, punishment and physical signs such as tiredness, lack of interest in sex and weight loss (Beck and Alford 2009). The conventional cut-off score for depression is 10. Scores above this are considered to indicate depressive symptomatology (Forkmann et al. 2009). This concept of a cut-off involves a binary classification of depression rather than a continuous one for treatment and management purposes – a categorical frame which is the subject of much debate (e.g. Menninger 1963, Widiger and Sankis 2000, Blazer 2005, Cuthbert 2005, Parker 2006).

3. We had initially planned to recruit all participants from the same psychiatrist as a way of ensuring as much consistency as possible, and in order to establish a medical perspective on their diagnosis. However, difficulties with obtaining enough participants via this method meant that more than one recruitment method had to be used. Despite expanding recruitment methods, it nevertheless continued to be slow. This may have been due to the absence of a monetary incentive (which we could not offer due to limited funding).

4. One participant was excluded from the statistical analysis because she felt she had experienced triggers for roughly half of her episodes.

5. We did not exclude experiences of post-natal depression from this sample because we wanted a heterogeneous group. However, there is a debate surrounding the diagnosis of post-natal depression, and about whether it should be considered a completely separate category. One participant who participated in this study had initially been diagnosed with post-natal depression, but this diagnosis was changed to bipolar depression by the time of interview.