Social factors in the occurrence of depression and allied disorders

Abstract

A retrospective study was conducted in a sample of 80 unemployed men selected from an unemployment benefit office in London. Psychiatric state was assessed using reliable, clinically-oriented, criteria for the diagnosis of affective disorders (depressive and anxiety states), and the date of onset of any disorder ascertained. Feelings of shame over unemployment were rated using explicit criteria, and information on life events, and difficulties, and a variety of other social factors ,collected using established procedures. Among men who were well at the time of job loss, one in seven subsequently developed a relatively severe ('case') affective disorder, and one in three a severe or a mild ('borderline case'?) disorder. Most of these were depressive states and had arisen in close proximity to the event of job loss. Factors found to increase the risk of onset of a disorder following job loss were (1) the lack of an intimate relationship with a wife or girlfriend (for the more severe disorders only) ; (2) economic difficulties antedating the present spell of unemployment (pre-existing money difficulties or a past history of insecure employment) and (3) the personality trait of shyness (each for the more severe and the milder disorders). Feelings of shame were reported by one in four men, and these were also associated with previous economic difficulties and with trait shyness. Shame was strongly associated with the onset of an affective disorder following job loss, and analysis indicated that the most likely explanation for this was that shame and affective disorder were both related to a common mediating factor, which it was suggested may have been chronically low or acutely damaged self-esteem.