G W Brown, B Andrews, T Harris, Z Adler & L Bridge, 1986

AIMS:  Brown et al wanted to test whether self-esteem and social support affected the likelihood of suffering Depression in the year following a stressful event. This study focussed on working-class women because females from lower socio-economic groups are more likely to be diagnosed with Depression.

Earlier research - including Brown, Harris & J Peto (1973) and Brown & Harris (1978) - had indicated vulnerability factors included low self-esteem, a lack of close relationships and the quality of a woman’s relationship with her husband or partner.

PROCEDURE (METHOD):  The design was prospective. The participants were 395 mostly working-class women, randomly selected from the sample who responded to a letter from their GP asking them to take part. They were aged between 18 and 50 and from Islington in North London. They all had at least one child under 18 at home and a husband or partner who worked in a manual occupation – though single mothers were also included. The initial interview assessed mental health, self-esteem and social support (ties with husband/partner, friends and relatives), using a range of standard interview schedules.

A year later 353 of the participants consented to a follow-up interview. This re-assessed the same variables. It also looked for major stressful life events that had happened during the year, using the Life Events & Difficulties Schedule. Particular attention was paid to crisis support (social support) received during stressful life events.

50 participants who had shown indications of Depression in the initial interview were not included in the follow-ups.  60 women were interviewed intensively. 21 women were used in a reliability study, with 11 being interviewed by 2 interviewers while 10 were rated by a second person using tapes from the initial interviews. Inter-rater reliability was satisfactory.

FINDINGS (RESULTS): About half of the women (150) had experienced a severely-stressful life event during the year. 29 (91% of the 32 participants who experienced Depression during the year had experienced a such life event, as compared to 23% of the women who had such a life event but did not experience Depression. The difference was significant at the p ≤ 0.01 level.

33% of those who developed Depression had a negative evaluation of their self while 13% did not. Low self-esteem did not make the women more vulnerable to Depression unless there was a stressful life event; but it did make Depression more likely when that kind of life event did occur.

The general level of social support, as assessed at the initial interview, was not associated with Depression. However, in those who suffered a stressful life event, those who were given good crisis support by a husband or partner  - 92% (85 of 92) - were less likely to suffer Depression. Of those women who had good social support at the initial interview but not at the time of crisis, 42% (14 of 33) developed Depression. Of those who had no social support either at initial interview or time of crisis, 44% (4 of 9) developed Depression.

CONCLUSIONS: Both low self-esteem and lack of social support make it more likely that stressful life events will lead to Depression. However, there was no evidence that either factor led to Depression without there being stressful life events.

CRITICISMS (EVALUATION): The study gathered in-depth and detailed data, using trained interviewers and a semi-structured interview format that allowed detailed information to be explored.

The study did not separate out instances where the woman’s husband or partner was part of the problem leading to the onset of Depression.

The study can be accused of gender bias (females only), cultural bias (working class) and sample bias (demographically and geographically-limited), making it difficult to generalise from it.