استرس مزمن و بهبود ضعیف شده در افسردگی بیش از 1 سال: تعدیلکنندگی در کمالگرایی

This study of depressed outpatients (N = 47) examined self-criticism (SC) and personal standards (PS) dimensions of perfectionism as moderators of the relation between chronic stress and depression over 1 year. Participants completed personality measures (SC, PS, neuroticism, conscientiousness) at baseline (Time 1), a chronic stress interview 6 months later (Time 2), and self-report and interviewer-rated depression measures at Time 1, Time 2, and 1 year after baseline (Time 3). Hierarchical multiple regression analyses of moderator effects demonstrated that patients with higher SC or PS and higher achievement-related chronic stress had higher levels of both self- and interviewer-rated depressive symptoms at Time 3 relative to those of other patients, adjusting for the effects of Time 1 and Time 2 depression scores. SC also interacted with interpersonal chronic stress to predict attenuated improvement in both self- and interviewer-rated depression at Time 3. The broader traits of neuroticism and conscientiousness did not interact with chronic stress to predict depression at Time 3. Our results highlight the importance of targeting perfectionists’ dysfunctional characteristics (e.g., contingent self-worth, coping, interpersonal functioning) that perpetuate a chronic sense of hopelessness in the context of chronic stress in order to produce a better treatment response for these individuals.

Over the past two decades, perfectionism has received increasing theoretical and empirical attention as a cognitive-personality factor that plays an important role in the etiology, maintenance, and course of depression (see Blatt, 2004, Egan et al., 2011 and Flett and Hewitt, 2002). Perfectionism has been found to be relatively stable over time (see Zuroff, Mongrain, & Santor, 2004) and to have a negative impact across several brief treatments of depression at termination and follow-up up to 18 months later (see Blatt and Zuroff, 2005 and Kannan and Levitt, 2013, for reviews). Several studies have examined a perfectionism diathesis-stress model, which posits that the effects of life stress (e.g., failure) on depression are intensified for individuals with higher levels of perfectionistic vulnerability (see Blatt and Zuroff, 1992 and Hewitt and Flett, 1993). Diathesis-stress models have focused on the role of major life events in the development of depression, but there is evidence that chronic stress is a stronger predictor of depressive symptoms than acute stress (see Hammen, 2005). Despite the obvious relevance of chronic stress to chronic depression, little research has examined when the effects of chronic stress on the maintenance of depression are likely to be maximized or minimized. The main purpose of the present study was to examine whether perfectionism moderates the relation between chronic stress and depressive symptoms over 1 year in a sample of depressed patients.

The present study suggests that chronic stress impedes improvement in depression symptoms over time for individuals with higher levels of SC/PS perfectionism. Although depressed patients in the present study got better on average, those with higher levels of perfectionism in combination with higher levels of achievement-related chronic stress exhibited less improvement in their depression symptoms. Whereas PS has been found to be the more adaptive dimension of perfectionism (e.g., Stoeber & Otto, 2006), this study showed that it may become maladaptive when faced with ongoing difficulties. SC perfectionism predicted heightened vulnerability across chronic stress domains, indicating pervasive vulnerability to ongoing difficulties. The results also further distinguished perfectionism from neuroticism and conscientiousness in terms of vulnerability to depression in the context of chronic stress.