Interpersonal clusters in a depressed outpatient sample

Abstract

Background: Prior research suggests that DSM diagnostic classification alone does not provide a full clinical picture for psychotherapy patients. Interpersonal problems are a promising area of research to aid in understanding patient experience and functioning, as well as build upon our existing understanding of psychotherapy treatment processes and outcomes. Methods: 71 outpatients were enrolled in individual psychodynamic psychotherapy and received a DSM-IV diagnosis of a depressive spectrum disorder. Each patient's current major depressive episode symptoms, global assessment of functioning (GAF) score, and interpersonal functioning were assessed pre-treatment. Hierarchical cluster analysis was used to investigate whether interpersonal “types” could be identified. Results: Hierarchical cluster analysis produced a 3-cluster solution that indicated 3 distinct interpersonal subtypes: 1) Non-assertive; 2) Socially Avoidant; and 3) Overly Nurturant. The subtypes did not significantly differ in terms of depressive diagnosis, global symptomatology, current major depressive episode symptoms, or GAF score. However, the Socially Avoidant cluster demonstrated significantly more male patients than the Non-assertive or Overly Nurturant clusters (p = .014). Limitations: The current study utilizes a small sample size (N = 71), which limits statistical power. Findings must be interpreted with caution. Additionally, DSM-IV diagnostic classifications were used. Conclusions: This study suggests the existence of three interpersonal profiles in depressive disorders: non-assertive, socially avoidant, and overly nurturant. These presentations, independent of quantitative levels of distress, imply that DSM-V classifications are insufficient to understand a patient's clinical presentation. It may be important to assess a patient's interpersonal functioning early in order to improve psychotherapy process and depression outcomes.

Keywords

• Psychodynamic psychotherapy
• Depression
• Interpersonal problems
• Cluster analysis