This investigation will utilize a prospective design to examine the impact of spousal expressed emotion (i.e., critical, hostile attitudes towards an identified patient by a spouse) and spousal support (i.e., constructive, helpful attitudes and behaviors towards an identified patient by a spouse) on the course of major depression. While expressed emotion has been hypothesized to be associated with a poorer course of depression, results studying this relation have been mixed. One possible reason for the inconsistent findings is that expressed emotion has been studied independent of other aspects of the marital relationship, such as spousal support. However, recent social support research suggests that spousal criticism and support are independent aspects of marital functioning, not simply two poles of a common underlying latent variable, and have differential effects on psychological distress. Currently, the relation between spousal expressed emotion and support, and their independent and interactive effect on the course of major depression, has not been studied. Developing a better understanding of the relation between spousal expressed emotion and support, and the course of depression would have direct implications for the treatment and prevention of this disorder. The current proposal will examine the effects of spousal expressed emotion and support using a naturalistic, prospective design. One hundred patients will be recruited during an episode of major depression. Symptom patterns will be assessed initially at baseline, and again at a 9-month follow-up, utilizing self-report and interview-based measures. Spousal expressed emotion and support will be assessed using comprehensive interview-based and self-report measures at baseline. Analyses will address three main study goals. First, this study will examine whether spousal expressed emotion and support are actually independent constructs, or rather two poles of a common underlying latent variable. Second, we will determine the independent impact of both spousal expressed emotion and support on the course of major depression. Finally, we will investigate the interactive relation between these constructs, particularly whether spousal support buffers the effects of expressed emotion on the course of depression.
