Substance-induced and independent major depressive disorder in treatment-seeking alcoholics: associations with dysfunctional attitudes and coping.

Abstract

This study examines the validity of the distinction between substance-induced and independent major depressive disorder (MDD) among alcoholics utilizing variables theoretically linked to the etiology and course of depression: specifically dimensions of coping and dysfunctional attitudes about the self that can lead to extreme negative interpretations of life events. Participants were 166 alcohol-dependent patients with elevated depressive symptoms. Comparisons were made between participants who met criteria for a current substance-induced major depressive episode and did not have a history of independent MDD (SIDD) and those who met criteria for a current major depressive episode and had either a past or current episode of independent MDD (IMDD). We also compared both of these groups to participants who have never met criteria for a depressive episode (NMDE). Depressive symptoms were correlated negatively with dimensions of adaptive coping and positively with maladaptive coping and dysfunctional attitudes. Women were overrepresented in the IMDD group, but the diagnostic groups did not differ significantly in other demographic characteristics or in measures of substance use. Participants with IMDD reported greater dysfunctional attitudes than those with NMDE and those with SIDD, who did not differ from each other. Frequency of antidepressive coping behaviors was lowest among those with IMDD, was significantly higher in those with SIDD and was highest among those with NMDE. Results suggest depressed alcoholics who have experienced episodes of depression independent of excessive substance use possess cognitive vulnerabilities and coping deficits that may render them prone to depression.