The interrelatedness of observed behavior of depressed patients and of a psychiatrist: an ethological study on mutual influence

The interaction of 61 severely depressed hospitalized patients and a psychiatrist was studied during a clinical interview. Interactional processes were defined by the use of ethological methods. Various observed behaviors were clustered on the basis of statistical criteria, yielding behavior factors of the patients and of the psychiatrist. The present paper deals with the organization of the psychiatrist's behavior and the interrelatedness of the patients' and the psychiatrist's behavior. Analysis of the behavior of the psychiatrist revealed seven factors: restlessness-1 (head, leg movements, object touching), restlessness-2 (body touching, head movements), speech (speech, gesticulating, yes and no movements), active listening (intensive body touching and hand movements), turn-taking (leg movements and gesticulating during listening), encouragement (back-channel behavior and yes-nodding), and change-looking (looking and head movements). Within the constraints of studying interactions which are bidirectional, it was found that restlessness-2, speech, encouragement and active listening of the psychiatrist could be 'predicted' from observed behavior of the patients (multiple regression model). The psychiatrist's behavior was related both to the severity of depression and to observed behavior not directly associated with severity. The psychiatrist's behavior was more strongly related to that of the more severely depressed patients than to that of the less severely depressed patients. These results contribute to an understanding of the behaviors displayed and elicited by depressed patients during a first encounter with a stranger

Depressed patients' perceptions of facial emotions in depressed and remitted states are associated with relapse

Within the framework of interpersonal and cognitive theories of depression, we investigated whether the perception of facial emotions was associated with subsequent relapse into depression. The 23 inpatients with major depression who remitted (65 admitted patients) were studied at admission (TO), at discharge (TI), and 6 months thereafter to assess relapse. They judged schematic faces with respect to the expression of positive and negative emotions. Six patients (26.1%) relapsed. High levels of perception of negative emotions in faces, either assessed at TO or at T1, were associated with relapse. Moreover, subjects saw more negative emotions in depressed than in remitted state. Significant results were confined to ambiguous faces, i.e., faces expressing equal amounts of positive and negative emotions. Our data support the hypothesis that a bias toward the perception of others' facial emotions as negative is an enduring vulnerability factor to depression relapse and depressed mood amplifies this negative bias in perception

Analysis of observed behaviors displayed by depressed patients during a clinical interview:relationships between behavioral factors and clinical concepts of activation

In 61 drug-free depressed patients, relationships were studied between observed behaviors and measures of common clinical concepts of activation. The behaviors were observed during a clinical interview and analyzed with ethological methods. Activation was assessed by means of self-ratings (Thayer, AD-ACL) and global judgment (Hamilton, retardation, agitation). Various aspects of patients' speaking and listening behaviors were recorded and analyzed, such as looking, head movements, yes-nodding and no-shaking, leg movements, gesturing, and body and object touching. A factor analysis was applied, enabling grouping of behaviors without using a priori concepts. Five factors reflected different aspects of a conversation: restlessness (leg and hand movements), speech, active listening (head movements and intensive body touching, during listening), speaking effort (looking, gesticulating, head movements, during speaking), and eagerness (yes-nodding and no-shaking). Significant positive relationships were found between the speech factor, the speaking effort factor and the restlessness factor on the one hand, and activation on the other. The eagerness factor was related negatively with activation. The results give insight into the organization of behavior during an interview, and show how this is related to clinical concepts of activation

Observed behaviors during clinical interviews predict improvement in depression

A considerable percentage of depressed patients do not respond to antidepressive treatment. Early indicators of prognosis are needed. The aims of this study are to examine (a) whether the interpersonal behavior of patients and psychiatrist, as assessed by means of direct observation of behavior during a baseline clinical interview, might have predictive value with respect to therapeutic outcome and (b) which predictive potency measures of psychomotor activation, as assessed by less refined methods, such as global clinical judgment, might have. In the analysis used, speech-pause behavior was taken as the basic structure of the interaction. The relations of other behaviors such as looking and hand and head movement with this structure were determined. Evidence is presented that in a group of 31 depressives, improvement after a period of 10 weeks was related to observed behaviors during a baseline interview. The behaviors of the patients are interpreted as “relational” or “nonrelational.” The relational behaviors (i.e., looking yesnodding, gesturing) occur less in patients who will improve, whereas the nonrelational behaviors (i.e., intensive body touching, head movements) occur more in these patients. The nonrelational behaviors are presumed to be indicative of the state of arousal. The predictive potency of these variables could not be explained by their relationship with the baseline severity of depression, which in itself also predicted improvement. Moreover, global clinical assessment of psychomotor activation (i.e., retardation and agitation) could not be related to outcom