Depression and interpersonal rejection

CXnrcal Prycholosy Reoiew,

Vol. 12, pp. 433-449, Printed in the USA. All rights reserved.

1992 Copyright

0272.7358192 $5.00 + .oo @ 1992 Pergamon Press Ltd.

DEPRESSION AND INTERPERSONAL REJECTION David K. Marcus Sam Houston

University

Mary E. Nardone College

of the Holy

Cross

ABSTRACT. Research on depression and interpersonal rejection was reviewed. Most of this research was generated by Coyne’s (19766) model. The strongest support for Coyne’s model was found when long-term relationships were examined, or when confederates or role-enactments were employed for short-term interactions. Fourfactors that may accountfor these results were discussed: (a) methodological and measurement issues, (b) the psychology of inevitability, (c) self; resentational factors and the situational nature of depression, and (d) the heterogeneity of depression. It was concluded that future researchers should (a) avoid using confederates and role enactments, (6) develop a theory to describe short-term interactions with depressed individuals, (c)focus more on the consequences of rejection (and other responses) for subsequent depressive behaviors, and (d) explore individual dzfferences in responses to depressed people.

In the 15 years since Coyne (1976b) proposed an interpersonal model of depression, numerous investigators have examined whether depressed individuals elicit a greater degree of rejection from others than do nondepressed individuals. Unfortunately, these studies have yielded a bewildering series of inconsistent results. Numerous studies found that depressed individuals are rejected more than nondepressed individuals, but a variety of investigators failed to find any rejection effect. The aim of this paper is to review systematically the literature on the rejection of depressed individuals, and to suggest possible explanations for the equivocal results these studies have obtained. Although not all investigators who examined the interpersonal consequences of depression did so from within Coyne’s framework, his model emphasizes the role of rejection in the etiology and maintenance of depression more than most other interpersonal models (e.g., Coates & Wortman, 1980; Wiener, 1989). Therefore, it may be appropriate to summarize Coyne’s model before discussing the research literature. Correspondence Sam Houston

should be addressed State University,

to David K. Marcus,

Huntsville,

TX

77341. 433

Division

of Psychology

and Philosophy,

D. K. Marcus and M. E. Nardone

434

Coyne (1976b) explained the development and maintenance of depressive patterns of behavior by focusing on the interpersonal consequences of emitting such behaviors. He explicitly contrasted his model with popular cognitive theories of depression (e.g., Abramson, Seligman, & Teasdale, 1978: Beck, 1967) that emphasize the “cognitive distortions” made by depressed individuals. Coyne noted that most have in a dysphoric manner, others respond with concern made to cheer the dysphoric partner and possibly reduce However, if the depressive behavior continues, others

often when individuals first beand helpful intent. Attempts are negative affect with distractions. begin to feel angry and hostile

because they are unable to understand the persistence of the depressive symptoms. At the same time, the others are inhibited from directly expressing annoyance and hostility because we have all learned not to criticize or attack someone who is suffering. Instead, they respond by giving verbal assurances while simultaneously emitting negative nonverbal cues. The “discrepancy between the verbal content and affective quality” (Coyne, 1976b, p. 34) is a mixed message that the depressed

individual

cannot decipher.

Although

the

others assure the depressed individual of his/her worth, the depressive is unable to determine the genuineness of the reassurance or the reliability of the others. Rather than risk abandonment or criticism, the depressed individual escalates depressive behaviors. Ultimately, the others either leave the field or avoid the depressed individual, or the spiral continues and they get locked in a pattern of “mutual manipulation” (p. 34). Thus, in contrast to cognitive explanations of depression, Coyne argued that the depressed individual accurately perceives that he or she is rejected by others. Currently, Coyne (1990) acknowledges that his model of depression

only “provides an

incomplete picture of the interpersonal processes in depression” (p. 39). In recent work, Coyne has examined the children of depressed parents (Downey & Coyne, 1990), specific marital interactions in depression (e.g., Coyne, 1990), and the role of victimization in depression (Coyne & Downey, 1991). H owever, rejection still appears to be central to Coyne’s interpersonal investigated construct

descriptions of depression and continues in interpersonal studies of depression.

to be perhaps

the most

RESEARCH ON INTERACTIONS Throughout

the research

on interactions

with depressed

individuals,

investigators

have

examined the ways people behave with those who are labeled depressed and/or how people report feeling after these interactions. Importantly, however, in many of the studies on “interactions” with “depressed” individuals subjects have not interacted with targets who are depressed. Studies using depressed targets (i.e., patients diagnosed as depressed or individuals scoring above a cutoff on a depression scale) are reviewed first and in greater detail, with the remaining studies (i.e., those using confederates or hypothetical cases) discussed thereafter.

Depressed Targets Short-Term Interactions. In the first experimental study to examine his model, Coyne (1976a) had female subjects speak on the telephone for 20 min with either depressed female outpatients (Zung Self-Rating Depression Scale (SDS) > 55), nondepressed female outpatients (SDS) < 40), or female normal controls. Those subjects who spoke with depressed targets reported feeling more depressed, anxious, and hostile on the Today Form of the Multiple Affect Adjective Check List (MAACL) than did subjects who had interacted with the nondepressed targets. Coyne also found that the depressed targets

Depression and Rejection

were rejected

more than either of the other two target groups.

the conversations conditions.

435

between

subjects

Coyne interpreted

and targets

However,

did not differentiate

these results as supporting

an analysis of

among

the three

his model of depression.

Since this first study by Coyne, other studies involving short-term interactions with depressed targets yielded inconsistent results. Strack and Coyne (1983) unambiguously replicated Coyne’s (1976a) findings that depressed individuals are rejected more than nondepressed individuals and that interacting with a depressed person induces negative moods. Strack and Coyne’s study was also designed to test Coyne’s original hypothesis that others do not provide depressed individuals with direct negative feedback. Female college students who scored below 2 on the Beck Depression Inventory-Short Form (BDI-SF) spoke in person for 15 min with female college students who scored above 6 on the BDI-SF (depressed targets) or with female college students who scored below 2 on the BDI-SF (nondepressed controls). Before completing the acceptance-rejection scales, subjects were either told that their responses would be read by the person they had just met or that their responses would be kept entirely confidential. Those who interacted with the depressed targets reported feeling more depressed, anxious, and hostile (on the MAACL) than did the subjects who interacted with the nondepressed controls. The depressed targets were also rejected more than the nondepressed controls. However, there was no interaction between target and confidentiality of response: Subjects’ responses to the depressed targets were as direct and unambiguous as their responses to the nondepressed targets. Other investigators,

however,

failed to replicate

Coyne’s

findings.

King

and Heller

(1984) performed a straight replication of Coyne’s (1976a) original study. They employed Coyne’s procedure (having subjects speak on the phqne with targets for 20 min) and used similar subjects and targets. The only apparent difference between the two studies was that King and Heller used a somewhat lower cutoff on the SDS for identifying depressed targets (48 instead of 55), but their targets all met the research diagnostic criteria (RDC) for major depressive disorder. They found neither negative mood induction nor rejection effects. Although the study did not yield any statistically significant results for mood induction, it is worth noting that the direction of the results was opposed to that of the hypotheses: Subjects meeting with depressed targets reported the least depression, anxiety, and hostility. Similarly, McNeil, Arkowitz, and Prichard (1987) failed to find negaor rejection effects (measured using tive mood induction (as reported on the MAACL) the Interpersonal Judgment Scale: IJS) w h en subjects met in person for 15 min with depressed outpatients (BDI > 15), compared to either nondepressed outpatients (BDI < 5) or normals. Nor did they find any differences across the three conditions in the verbal and nonverbal behaviors of the subjects during the interaction. Aside from using the BDI instead of the SDS to identify depressed targets, the primary difference between this study and Coyne’s (1976a) was that subjects did not speak to targets by phone but instead met face-to-face with them. Working

with a student

population,

Gotlib

and Robinson

(1982)

failed to find any

rejection effects or negative mood induction (again using the MAACL) when subjects met with depressed targets (BDI > 8), compared to nondepressed targets (BDI < 7). However, they did find that subjects who interacted with depressed targets “smiled less often, demonstrated less arousal and pleasantness in their facial expressions, talked about less positive and more negative content in their conversations, and made fewer statements of direct support” (p. 231) than did subjects who interacted with nondepressed targets. Borden and Baum (1987) examined sex differences in subjects’ (BDI < 2) responses to mildly depressed (BDI > 10) male and female students. They found no differences in how the depressed targets behaved during the interactions as compared to the nonde-

D. K. Marcus and M. E. Nardone

436

pressed targets. Nor did they find negative mood induction (using the MAACL). Although they reported a rejection effect for depression, closer analysis indicated that “sex, and not depression status,” accounted for differences in degree of rejection, with male targets “rejected whether depressed or not” (p. 463). In another study using face-to-face interactions, Dobson (1989) also failed to find any rejection effects or negative mood induction (using the MAACL) when depressed female college students (BDI > 9) interacted with nondepressed female students (BDI < 10). However, he did find that the depressed targets believed that they were more rejected than nondepressed targets, and he interpreted these findings as providing greater support for a cognitive model than for an interpersonal one. Similarly, Paddock and Nowicki (1986) found that female college students who met with depressed female students (BDI > 10) were no more rejecting students (BDI < 10).

than subjects who met with nondepressed

but maladjusted

Most recently, Rosenblatt and Greenberg (1991) failed to find any rejection effects or negative mood induction (MAACL) w h en nondepressed students (BDI < 3) met with depressed students (BDI > 9) for a brief face-to-face interaction. However, they did find that the depressed subjects reported

greater negative mood induction

after interacting

nondepressed targets than they did after interacting with depressed targets. Thus, when investigators other than Coyne had subjects meet with depressed

with targets

for brief interactions, their findings have not supported the model. Reviewing this literature, Doerfler and Chaplin (1985) suggested that the problem with the research was that it involved a Type III error. Specifically, they noted that Coyne’s model emphasizes the long-term interactions between depressives and significant others in their social world, while these studies looked at short-term interactions between strangers. Doerfler and Chaplin suggested that future research on interpersonal models of depression focus on interactions between individuals who have been in long-term relationships (e.g., spouses, friends). Although Coyne (1985) defended the value of studying interactions ers, he has since focused on studying families with a depressed member.

with strang-

Long-Term Interactions. In the last 10 years, the role of spousal interactions in depression has received so much attention that a thorough review of this literature merits an entire paper. Still, a number

of studies seem to provide considerable

support for Coyne’s basic

thesis. Coyne, Kessler, Tal, Turnbull, Wortman, and Greden (1987) compared the burdens and psychological distress reported by adults who were living with a depressed spouse or significant other (diagnosed using the Schedule for Affective Disorders and Schizophrenia) to those reported by adults living with a formerly depressed other. They found that adults living with a depressed individual reported more burdens and experienced greater

psychological

distress (as measured

by the Hopkins

Symptom

Checklist:

HSCL-25) than did the controls who were living with a formerly depressed spouse. Furthermore, they found that 40% of the adults living with a depressed person met the HSCL-25 cutoff score for needing psychological intervention, while only 17% of the control group reached this cutoff score. Similarly, Krantz and Moos (1987) found that spouses of depressed people (met the RDC criteria for a unipolar depressive disorder) reported more problems on a variety of measures than did spouses of remitted depressed individuals or spouses of controls. In one of the more methodologically precise studies, Hops et al. (1987) examined interactions in families of depressed women. Women were identified as depressed only if they met the RDC criteria for a depressive disorder, scored above a 17 on the BDI, and were currently in therapy for depression. Hops et al. used the Living in Familial Environments coding system to code family interactions during ten l-hr home observa-

Depression and Rejction

tions. They found that depressed

women expressed

437

more negative

affect and less happy

affect during family interaction than did nondepressed mothers and, sequentially, that negative affect by depressed mothers suppressed other family members’ aggressive affect. Similarly, Nelson and Beach (1990) found that depressive behaviors of wives suppressed their husbands’ aggressive responses. However, they found that the suppression following depressive behaviors was stronger for discordant couples where the wife was not depressed than it was for discordant couples where the wife was depressed (BDI > 14 and diagnosed as being in a Major Depressive Episode). To explain this finding, they offered the provocative speculation that depressive behaviors are initially negatively reinforced by the cessation of hostility, but that over time the rate of reinforcement decreases and, as a result of the variable reinforcement schedule, the frequency of depressive behaviors by the wife increases. A number of researchers

examined

long-term

interactions

with depressed

individuals

by studying college roommates. Howes, Hokanson, and Loewenstein (1985) found that college students who lived with depressed roommates (BDI 3 11) for 13 weeks scored progressively higher on the BDI than did controls who lived with nondepressed roommates. In a more recent study, Hokanson, Rubert, Welker, Hollander, and Hedeen (1989) found that college roommates of depressives (BDI-SF > 8, and met the RDC criteria for a depressive disorder) reported more aggressive behavior towards their roommates and less enjoyment of their relationships with their roommates than did controls who lived with either a normal roommate or a roommate who met the RDC criteria for a psychiatric disorder other than depression. After comparison of 30-min videotaped conversations between roommate dyads that included a depressed roommate and those that did not, Hokanson et al. failed to find any significant differences in the number of positive or negative statements made. Burchill and Stiles (1988) also found that depressed college students (BDI > 15) were more rejected by their roommates than were nondepressed students (BDI < 4). Surprisingly, they also found that, while the depressed students’ roommates reported more negative mood on the MAACL before interacting with their roommates during the study, their moods improved over the course of the interaction. Sanislow, Perkins, and Balogh (1989) used the MMPI to identify depressed students and assessed the depressive symptoms and rejection reported by their roommates. They found that the most depressed mood and rejection was reported by the roommates of students who were not only depressed but also showed elevations on the Psychopathic Deviate, Psychasthenia, and/ or Schizophrenia scales of the MMPI. They concluded that mood and rejection effects may result from overall psychopathology and not specifically from depression. They aIso asked the subjects to complete a short form of the MMPI (MMPI-168) as they believed their roommates would. Interestingly, the roommates of depressed individuals were less accurate in their estimations of their roommates’ responses than either the roommates of normal individuals or the roommates of “spike-9” students (elevated hypomania scale). Siege1 and Alloy (1990) found that mildly depressed male students (BDE < 8 and MMPI-D

t score > 55) were more negatively

evaluated

(on a series of questionnaires

designed for the study) by their roommates than were anxious or normal male students. Depressed female students were not evaluated more negatively by their roommates, but they did report that they believed their roommates evaluated them negatively. This study may also be significant as one of the first attempts to integrate interpersonal and cognitive approaches to depression. It appears that the more ecologically valid studies that examined long-term relationships provide more consistent support for Coyne’s model. Spouses and roommates of depressives both report greater levels of depression and distress than do those who live

D. K. MarcusandM.

438

E. Nardone

with nondepressed individuals. The studies by Hops et al. (1987) and Hokanson et al. (1989) may even be taken as providing support for Coyne’s assertion that depressives receive mixed messages. The Hops et al. study showed that depressive behavior suppresses overt displays of aggression, and in the Hokanson et al. study the subjects were critical of their depressed roommates on the confidential questionnaires but were no different from the other dyads when they were face-to-face with their roommates. All of these findings support Doerfler and Chaplin’s (1985) argument that Coyne’s model is more relevant to long-term relationships than it is to interactions between strangers. Simulated

Depression

Researchers have employed two very different methods depressed individuals. In four studies subjects actually enacted a depressed role, while in other studies subjects would say to and how they would feel while interacting role-enactment studies). interactions

With Confederates.

Researchers

for simulating interactions with interacted with confederates who were asked to imagine what they with a depressed individual (i.e.,

who used confederates

as their targets have

been more successful at finding rejection effects and negative mood induction effects after short-term interactions than researchers who used actual depressives as their targets. In all four studies (Hammen & Peters, 1978; Howes & Hokanson, 1979; Marks & Hammen, 1982; Stephens, Hokanson, & Welker, 1987). mvestigators found that subjects were more rejecting of confederates who enacted a depressed role than of confederates who enacted a nondepressed role or (in the Howes & Hokanson study) a physically ill role. Furthermore, both Hammen and Peters (using the Wessman-Ricks lo-point Elation-Depression scale) and Marks

and Hammen

(using the MAACL)

found negative

mood induction

reported by the subjects when the confederates enacted the depressed role. Neither Howes and Hokanson (1979) nor Stephens et al. (1987) found any negative mood induction using the MAACL. Simulated lnteractions (Role Enactments). Other investigators have used methods in which subjects do not meet the targets, but instead (a) listen to an audiotape of an interview with an actual depressive (Boswell & Murray, 1981), (b) observe an interview with an actual depressive from behind a one-way mirror (Nelson-Gray, Lin, & Torquato, 1991), (c) watch a videotape of a confederate (Amstutz & Kaplan, 1987; Gurtman, 1986b; Gurtman, 1987; Gurtman, Martin, & Hintzman, 1990) (d) listen to an audiotape of a confederate (Frank et al., 1987; Lynn & Bates, 1985), (e) read transcripts that describe different individuals (Gotlib & Beatty, 1985; Hammen & Peters, 1977; Winer, Bonner, Blaney, & Murray, 1981), or (f) read the BDI protocols of fictitious people (Rosenblatt & Greenberg, 1988; Sacco, Milana, & Dunn, 1985). All 13 of these studies found that, when subjects were asked to imagine their reactions to the targets they viewed, listened to, or read about, they were more rejecting when the target was depressed than when the target was described as or acted in a nondepressed manner. The only minor exceptions were Boswell and Murray (1981), Gotlib and Beatty (1985), and Hammen and Peters (1977). Boswell and Murray (1981) found no differences between subjects’ rejection of depressed targets and schizophrenic targets. They did find that the patients (both depressed and schizophrenic) were rejected more than the controls. Gotlib and Beatty found that depressed targets were rejected more than normal targets, but were not rejected more than physically ill targets. Hammen and Peters (1977) found that depressed males were rejected more than anxious or flat affect males, but that there was no rejection

Depression and Rejkction

439

effect for depressed females. After having subjects read BDIs of fictitious depressed individuals, Sacco, Milana, and Dunn (1988) f ound that long-duration depressives were rejected more than short-duration depressives. When negative mood induction has been examined, results have not been as consistent. Gotlib and Beatty (1985) found that subjects in the depressed condition reported higher levels of depression, anxiety, and hostility on the MAACL. Winer et al. (1981) found negative mood induction on the Mood Adjective Check List in the depressed condition, and Gurtman et al. (1990) found negative mood induction on the Profile of Mood States. Sacco et al. (1985) also found that the subjects who were given BDI profiles to read and asked to imagine responding to a request for help from the target reported greater anger when the protocol depicted a depressed person. However, Amstutz and Kaplan (1987), Frank et al. (1987), and Lynn and Bates (1985) all failed to find any negative mood induction when subjects were presented with depressed targets. DISCUSSION Two patterns

may be discerned

from this review that incorporate

virtually

all of the

studies (the exceptions are Coyne, 1976a; Strack & Coyne, 1983). The first pattern is the consistently strong support for Coyne’s model when long-term interactions are studied. The second pattern is that, when short-term interactions between strangers are studied, the support for Coyne’s model is strongest the further one gets from actual interactions with clinically depressed targets. That is, confederates or transcripts and tapes of depressed targets more consistently elicit rejection and negative mood effects than do interactions with depressed individuals. Initially, this second pattern of results may seen counterintuitive. One would think that if depressives did elicit rejection and induce negative moods in those who interacted with them, then actual depressives should have a greater impact on subjects than confederates who are simply enacting a role, and certainly a greater impact than a voice on a tape or a packet of papers. Nevertheless, real depressed people do not reliably elicit rejection from strangers during brief interactions. There are at least four factors that may account for this pattern of results and lend coherence to this research area. These factors are (a) methodological and measurement issues when identifying depressed targets, (b) the “psychology of inevitability” (Darley & Berscheid, 1967), (c) the self-presentations of depressed individuals and the situational nature of depression, and (d) the heterogeneity of depression. These explanations are not mutually exclusive. On the contrary, they may all contribute to the development of a more complete interactional 1. Methodological A number

model of depression.

and Measurement

of measurement

Issues

issues may contribute

to the equivocal

results found in the

literature. Researchers have not been consistent in how they identify depressed target individuals. Although most investigators used the BDI of the BDI-SF to identify depressed targets, there has been considerable variation in the cutoff scores used. Cutoff scores for identifying depressed individuals using the BDI have ranged from as low as 9 (Gotlib & Robinson, 1982) to 15 (McNiel et al., 1987), so that the average depressed target in the Gotlib & Robinson (A4 = 14) study would not have made the minimum both Coyne (1976a) and King and cutoff for the McNiel et al. study. Furthermore, Heller (1984) used the SDS instead of the BDI. Yet, reviewers (e.g., Hedlund & Vieweg, 1979; Rabkin & Klein, 1987) suggest that the SDS is of questionable value for diagnosing depression or even for estimating the severity of depressive symptomology. Of most importance, while some investigators limited their depressed targets to individuals who

D. K. Marcus and&f.

440

E.

Nardone

met diagnostic criteria for a depressive disorder (e.g., Hokanson et al., 1989; Hops et al., 1987) others relied on severity of depression (as measured by a self-rating scale) without concern for the diagnosis (e.g., Coyne, 1976a). For example, in the McNiel et al. (1987)

study the primary

anxiety disorder,

diagnosis

and for another

for one of the “depressed” targets was generalized

it was anorexia.

The larger issue here is that originally

Coyne and other interpersonal

theorists had not been explicit about whether they treated depression as a mood, as a symptom, or as a syndrome, and researchers have been similarly inconsistent. Most recently, Coyne and Downey (1991) stressed that clinical depression may have different interpersonal origins and consequences than general distress and dysthymia, which may be reflected by an elevated score on a depression scale. A related issue is the choice of target individuals for the controls. Numerous studies used only normal individuals as targets for the controls (e.g., Howes et al., 1985; &rack & Coyne, 1983). Even when these studies yielded significant differences between the depressed and the controf conditions, it has not been possible to conclude that these differences are unique to depression. The rejection or negative mood induction may be the result of interaction with individuals who are distressed or behave in a deviant manner. Among those studies that did use distressed or disturbed individuals who were not depressed as targets, only Coyne (1976a), Hokanson et al. (1989), and Sanislow et al. (1989) found differences between reactions to depressed targets and responses to other -not normal” targets. Both King and Heller (1984) and McNiel et al. (1987) compared reactions to depressed targets and to other nondepressed patients and failed to find any differences. Therefore, the interpersonal pattern originally described by Coyne may not be unique to depression. The larger issue here is that traditional diagnostic categories drawn from a medical model (i.e., DSM-III-R) may not be the most useful for interpersonal theories of abnormal behavior. Instead of a symptom-based taxonomy, theorists working from an interpersonal perspective may do better to draw on transactional taxonomys (e.g., Kiesler, 1983; Leary, 1957). Coates and Wortman (1980) p ro p osed an interpersonal model that describes the responses of others to any suffering individual (e.g., depressives, rape victims, individuals with cancer). Similarly, Wiener (1989) d escribed a set of interactional patterns that may be found in depression, but some of these patt_erns may also be found in with other psychological disorders (e.g., anorexia nervosa, Marcus &Wiener, 1989). Although neither of these models has yet generated many studies on interactions with depressives, perhaps each model’s lack of specificity with regard to depression may contribute to a revised interpersonal model. Finally, it is worth noting that use of the MAACL to measure subjects’ mood in all of the short-term interactional studies with depressives and in most of the simulated depression studies is problematic if investigators intended to specify the precise negative mood induced by interacting with depressives. In a factor analytic study, Gotlib and Meyer (1986) found that the MAACL contained only two factors, positive and negative affect. Similarly, the intercorrelation among the Depression, Anxiety, and Hostility subscales of the MAACL, reported by Zuckerman and Lubin (1985) are between .7 and .9. Therefore, it is not surprising that in all studies that found negative mood induction using the MAACL there were increases in depression, anxiety, and hostility, while those studies that failed to find negative mood induction failed to find increases in any of these three moods. Even if the negative mood induction findings had been more consistent, they would have been of little value for describing the precise nature of the subjects’ reactions. Zuckerman and Lubin (1985) revised the MAACL because of the high intercorrelations between these three scales, and the MAACL-R may be a more useful instrument for future research.

Depression and Rejection

Results

from this body of research

more consistency

among

researchers

441

might have been less equivocal in the selection

of depressed

if there had been

targets,

the types of

control groups employed, and greater precision in the measurement of affective response. However, methodological variations alone can not account for the inconsistencies. Studies that were maximally similar (Coyne, 1976a; Gotlib & Robinson, 1982; King & Heller, 1984; Strack & Coyne, 1983) yielded different results, while studies that employed very different methods yielded similar results. For example, Coyne (1976a) selected depressed targets from outpatient populations using the SDS and had subjects speak by telephone, Strack and Coyne (1983) selected targets from introductory psychology classed using the BDI-SF and the subjects met in person, while Winer er al. (1981) had subjects read transcripts of fictitious depressed individuals. Despite these different methods the results were highly similar. Therefore, although it is important to acknowledge the role of methodological variations, other considerations may be necessary to account for these inconsistent results. 2. The Psychology of Inevitability (1967) g ave women folders containing personality data that described two different women, and led the subjects to believe that they would be meeting with one of the women to discuss dating behavior and sexual standards. Half of the subjects were told it would be the woman described in one folder, and half of In a classic study, Darley and Berscheid

the women were told it would be the woman described in the other folder. They found that the subjects liked the woman who was going to be paired with them better than the other woman. Darley and Berscheid explained these findings using Heider’s balance theory: The subjects justified their preference for the woman they were going to be paired with because an interaction with that woman was inevitable and they were therefore in a One of Darley and Berscheid’s (1967) conclusions has important “unit relationship.” methodological implications for future judgments concerning another.

studies

in which one person

is asked to make

If the situation is introduced to the judge in such a way as to cause him to perceive a unit relationship between himself and the person he is judging, then, on the evidence of the present study, he is likely to increase his liking for the other person. (pp. 36-37)

More recently, Devine, Sedikides, and Fuhrman (1989) found that subjects processed social information differently, depending on whether the stimulus person was described as someone they would be meeting or not. It is important to note that, in 11 of the 13 studies reviewed in which the subjects did not meet with the targets but instead read about them, listened to them, or watched them, the subjects were asked to imagine what it would be like to meet these people. In only two of these studies (Amstutz & Kaplan, 1987; Lynn & Bates, 1985) were the subjects led to believe that they would actually be meeting with the target at a later point in the experiment. It may be easier to be critical of and reject another when there is no possibility of being judged by the other or having to face the other, or when no unit relationship has formed as the result of previous interactions. This tendency may “amplify” the rejection effects in these role-enactment studies. However, the primary reason for studying interactions with depressed individuals is to discover what people do with depressed individuals that may create or maintain depression. If, because of the psychology of inevitability, people are not as rejecting when forced to meet depressed individuals,

D. K. Marcus and M. E. Nardone

442

then the artificial amplification of the rejection effect in the role-enactment studies may turn out to be a red herring. If investigators use such methodology, it may be more valid to deceive subjects into believing that they will be meeting with the target. 3. Self-Presentation Although

and Situational

the psychology

Factors

of inevitability

may partially

explain

why subjects

were more

rejecting of depressed targets in the role-enactment studies than when they actually met with depressed targets, it does not explain why they were more rejecting in the confederate studies than in the nonconfederate studies. Here it is necessary to consider selfpresentational factors and contextual variations. Most of the interactions in the studies that involved actual depressed individuals lasted between 15 and 20 min. There is reason to think that all but the most severely depressed individuals are capable of behaving in a nondepressed manner during a short meeting in the context of a psychology experiment. Unlike many of the other researchers, both Borden and Baum (1987) and Burchill and Stiles (1988) examined the behaviors of the depressed targets as well as the behaviors of the subjects during the interactions. Neither found any significant differences between how the depressed targets behaved and how the other subjects behaved.

Further

indirect evidence

suggesting

that self-presentational

fac-

tors should be considered comes from the Sanislow et al. (1989) study. As the reader may recall, roommates of depressed students were less accurate in predicting how their depressed roommates would complete the MMPI- 168 than were roommates of normals or of hypomanic students. Unfortunately, the authors do not report whether the subjects underestimated or overestimated the degree of their roommates’ pathology. Finally, after failing to find either rejection or negative mood induction, McNiel et al. (1987) suggested that depression is more situation specific than researchers have acknowledged. In a number of studies, Hokanson and his associates examined the situational variability of depressed individuals’ social behavior. Using a Prisoner’s Dilemma game, Hokanson, Sacco, Blumberg, and Landrum (1980) f ound that depressed subjects behaved very differently when they were in a high power role (permitted to exploit without retaliation from the other player) than when they were in a lower the other player from exploiting them). Blumberg and in a cooperative problem-solving procedure, depressed confederates enacting different roles. Depressed subjects

power role (powerless to prevent Hokanson (1983) also found that subjects responded differently to responded with hostility to criti-

cal-competitive partners and with self-devaluation to helpless-dependent partners. Depressed sub.jects also reported using different social behaviors in different contexts (Meyer & Hokanson, 1985). Of importance, depressed (and nondepressed) subjects reported rarely communicating sadness with strangers. Most recently, Weary and Williams (1990) found that depressed subjects failed a simple visual-motor task when success would have resulted in having to do another task, but succeeded when performance was independent of future obligations. This study also underscores how subtle situational factors may influence depressive symptomatology. The BDI has been the instrument of choice for identifying depressed targets, yet it is easy to score in the 20s (a score that would have reached the cutoff in all of the studies reviewed) without endorsing any of the items that describe thinking or feeling a certain way “all of the time.” Clinically, it is common to see depressed clients who report not being depressed in some contexts (e.g., work), but who appear severely depressed in other contexts (e.g., therapy, home). On the other hand, the confederates used in the studies intentionally present in a depressed manner,

and in doing so they may behave very differently

from most depressed

Depression and Rejection

individuals. 1982;

Many

Rosenblatt

of the studies (e.g., & Greenberg,

1988)

443

Amstutz & Kaplan, 1987; Marks & Hammen, that used video or audio tapes of “depressed”

targets had manipulation checks where graduate students, psychologists, or the subjects themselves were asked if the targets presented in an appropriately depressed manner. It is less clear whether actual depressives also present in an appropriately depressed manner when meeting with strangers. 4. The Ii eterogeneity

of Depression

The final consideration is that depression may be understood as a heterogeneous category. A variety of investigators (e.g., Arieti & Bemporad, 1980; Younge, 1966) have provided evidence that depression is a heterogeneous category or that there are different subtypes of depression. For example, Blatt and his associates (e.g., Blatt, Quinlan, Chevron, McDonald, & Zuroff, 1982; Blatt & Shichman, 1983) have distinguished between an anaclitic or dependent type of depression, and a self-critical or guilty depressive style. The former pattern is “characterized by feelings of helplessness and weakness, by fears of being abandoned, and by wishes to be cared for, loved, and protected,” while the latter pattern involves “feelings of inferiority, guilt, and worthlessness” (Blatt, D’Afflitti, & Quinlan, i976, p. 383). These two depressive styles may elicit different types and degrees of rejection from others. Furthermore, the type of rejection (i.e., interpersonal or social rejection vs. criticisms of the person’s achievements) may have very different consequences for depressed individuals, depending on whether their style is more dependent or self-critical. Therefore, we would expect actual depressed targets (i.e., those who are identified on the basis of their scores on a depression scale or who are diagnosed as depressed) to behave in a variety of different ways. While all of these targets may at times be unhappy of dysphoric, some may be self-critical, others may appear hurt and frustrated, others may appear pessimistic and hopeless, and still others may behave in a variety of other ways. Thus, although all of the targets may ostensibly be depressed, it is not surprising that there would be enough variance within the depressed groups in these studies to greatly lower the possibility of finding between groups differences. Some support for this hypothesis comes from the Sanislow et al. (1989) study. They obtained stronger results when they subdivided their depressed target group into “primary depression” and “depression in conjunction with other psychological disturbance” (p. 350) subgroups than when they combined all of the depressed target into one group. Investigators who used simulations of depressed targets provided their subjects with homogeneous targets. All of the subjects saw the same videotape or read the same BDI protocol. Even when multiple video or audio tapes were employed to minimize confederate effects, investigators (e.g., Lynn & Bates, 1985) took precautions to make sure that the portrayals were identical and that similar precautions were taken when subjects actually interacted with the confederate (e.g., Howes & Hokanson, 1979). Of all the studies reviewed, only Winer et al. (1981) attempted to present subjects with different types of depression. In this study, subjects read transcripts of simulated interactions with either a basic depressed target, a guilty depressed target, an angry depressed target, a dependent depressed target, or a nondepressed target. Although they did not find any differences in the subjects’ reactions to the different types of depression, it is important to note that all four depressed transcripts were described as sharing the same basic elements (i.e, sad mood, pessimism, low self-esteem, feelings of powerlessness and helplessness, fatigue, and retardation), and the guilt, anger, or dependency was simply added to the transcript. So, even in this study, there was probably greater homogeneity among the

444

D. K. Marcus and M. E. Nardone

different depressed targets than there was in the studies that used actual depressives. Thus, in nearly all of the studies that used simulated depressed targets, within-group variance could only come from differences among the subjects and could not have resulted from differences in the targets. The “homogenization” of depressed targets increased the possibility of finding between-group differences, and this may be why these differences were found. However, if real depressed people are a heterogeneous group, then these confederate studies are at best only moderately generalizable to the population of depressed individuals.

CONCLUSIONS The greatest evidence for the interpersonal rejection of depressed individuals could be found when investigators examined the relationships between significant others (e.g., spouses, roommates) or when confederates or other simulations were employed. When short-term interactions between strangers are examined, the results are far more equivocal. However whenever Coyne (1990; Coyne, Burchill, & Stiles, 1991; Coyne & Downey, 1991; Coyne, Kahn, & Gotlib, 1987), and especially Gurtman (1986a) reviewed this literature, they concluded that the rejection effect is robust, even during short-term interactions. For example, Gurtman (1986a) asserted that “the rejection of depressed persons is consistent across studies and methodologies” (p. 99), and Coyne (1990) concluded that studies “have almost all found that depressed persons are negatively received” (p. 39). Although Gurtman’s initial conclusions could be explained by the fact that live of the seven failures to replicate a rejection effect following short-term interactions with depressives had not yet been published, much more recently Gurtman et al. (1990) reached the same conclusions. Therefore, it is necessary to try to account for the different conclusions reached in this review. Two factors appear to be responsible. When Gurtman lists the studies that support the rejection effect for strangers, he combines them across methodologies (actual depressives, confederate studies, and role enactments). However, a primary point of this paper is that actual interactions must be distinguished from simulated ones, and when they are, the literature looks very different. In Coyne’s reviews, there was a tendency to leave out most of the studies that failed to replicate. The Borden and Baum (1987) study, the Dobson (1989) study, and the McNiel et al. (1987) study were never referenced in any of his four reviews (of course, the Rosenblatt and Greenberg study could not be referenced because it was published in 1991). When King and Heller (1984) first published their failure to replicate, it was easy to dismiss it as the exception that proved the rule. However, since then six other published studies have appeared in which the investigators have not been able to replicate Coyne’s findings when subjects met with depressed strangers for brief interactions. Most recently, Segrin and Dillard (1991) p er f ormed a meta-analysis on studies examining the interpersonal nature of depression. Although they concluded that “the elicitation of interpersonal rejection appears to be a robust and reliable phenomenon” (p. 23), they also found that the rejection effect was greatest for long-term interactions and for studies using simulated depression. They found a smaller, but significant, rejection effect for short-term interactions with actual depressives, but this finding is problematic. As with the other reviews, it did not include Rosenblatt and Greenberg (1991) because this study was just published. McNiel et al. (1987), another disconfirming study, was not included in the primary analysis of rejection because they used the Interpersonal Judgment Scale to measure rejection. Of most importance, the Borden and Baum (1987) study yielded the largest effect size for rejection. This finding is disconcerting because Borden and

Depression and Rejection

445

Baum’s own analyses indicated that the sex of the subjects and not depression accounted for rejection. If the Borden and Baum study is eliminated from the meta-analysis, then once again it is only Coyne (1976a) and Strack and Coyne (1983) who were able to find a rejection effect when strangers interacted with actual depressives. These findings have important methodological and theoretical implications. It seems apparent that researchers can continue to generate statistically significant results using simulated depressed targets. It is less clear what, if anything, these results mean for an interpersonal theory of depression. Given the discrepancy between confederate studies and studies using actual depressed persons, there is little reason to think that the confederates are behaving like real depressed people. Furthermore, given the discrepancy between role-enactment studies and actual interaction studies, there is little reason to think that the subjects who are asked to imagine what it would be like to interact with a depressed person can accurately predict what they will do and how they will feel in these situations. Therefore, unless there is a specific theoretical or methodological justification for performing a role-enactment study, future researchers should concentrate on interaction studies with actual depressed persons. If the results from the role-enactment and confederate studies can be bracketed off, then it may be concluded from this review that Coyne’s model contributes to our understanding of how depressive behaviors are maintained in long-term relationships. There is no question that this is a major contribution, and it is, after all, consistent with the aims of the original theory (Doerfler & Chaplin, 1985). H owever, this model does not explain what role, if any, social interactions have in the creation and early development of depression. At this point, two challenges to researchers developing of depression are (a) to demonstrate that the rejection of depressed cant others does in fact lead to an escalation of depressive behaviors Coyne’s model in a way that will describe how short-term and

an interpersonal model individuals by signifiand (b) to supplement early interactions may

elicit depressive behaviors. Because rejection of depressed individuals in long-term relationships has been amply demonstrated, the first challenge is easier to meet. Methodologically, one way to address this issue is to employ a sequential analysis model, such as that used by Hops et al. (1987) and Nelson and Beach (1990) in their studies of responses to depressed family members. Until now, most researchers attempted to answer the question, Are depressed individuals rejected more than other individuals? An analysis of variance model has been sufficient to answer this question. Sequential analysis will allow us to determine what happens after a depressed person is rejected. It is not enough to demonstrate that depressed people are rejected more than others; it is also necessary to demonstrate that this rejection has consequences. Both Hops et al. and Nelson and Beach suggest that depressive behaviors may be maintained by negative reinforcement (i.e., depressive statements suppress spouse’s aggression and criticisms). Further, Coates and Winston (1983) found that support and validation by a peer group of other depressed individuals may help reduce depression, but it has not yet been demonstrated that rejection per se maintains depression. There have been few consistent findings when short-term interactions with depressed individuals were studied, so the second challenge is more difficult. The key will be to know where to look when examining these interactions. There are two interpersonal theories of depression that may be helpful. Because neither Coates and Wortman’s (1980) nor Wiener’s (1989) models emphasize rejection of depressed individuals, they might describe the early interactions better than Coyne’s model. Both Coates and Wortman and Wiener consider the possible negative consequences of people trying to be helpful

D. K. Marcus and M. E. Nardone

446

when interacting with depressed individuals. advantage of describing different depressive

Furthermore, interactional

Wiener’s model has the added patterns, and may address the

heterogeneity of depression. Still, future research is necessary is applicable to depressive interactions.

to see whether either model

Six years ago, Doerfler and Chaplin (1985) argued that studying short-term interactions among strangers was not an appropriate way to test interactional models of depression. Coyne (1985) responded that studying strangers may capture “the emergence of a depressive interactional pattern” (p. 231) and may thus exemplify the earliest stages of what ultimately become long-term interactions. Coyne’s argument is persuasive, has never been tested. It may be that all short-term studies, even those involving

but it actual

depressed subjects who are assessed at more than one point in time, are in a sense analogue studies. Brief interactions among strangers in an experimental context are likely to differ in crucial ways from the interactions among spouses, friends, and so on that precede or lead into a depressive episode. Coyne (1985) argued that studying interactions among strangers simplifies and clarifies the findings by avoiding the subjects’ history of previous interactions, but this simplification may oversimplify by eliminating the complex context from which depressive behaviors are likely to arise. Although far more difficult logistically, future studies on the early stages of depressive interactional patterns may be most useful if investigators examine the emergence of depressive patterns among people who are already in a relationship. A final issue that has been overlooked by researchers has to do with individual differences in how people respond to depressed individuals. Only Notarius and Herrick (1988) explored this issue. They found that subjects who responded with supportive listening techniques to a confederate enacting a depressed role reported more positive affect and less rejection of the confederate than did subjects who responded with advice-giving, chit-chat, and jokes. More studies like this one may provide the information necessary for developing a model that not only details possible behaviors by depressed participants in transactions but also the possible responses of others, and further explains how the interactions of people can either create and maintain or minimize subsequent depressive behaviors.

authors wish to thank Rowland Miller, Michele Larrow, Morton Wiener, Cheryl Hiscock, and two anonymous reviewers for their helpful comments on drafts of this manuscript. We also wish to thank Janet Borden for clarifying the results of the Borden and Baum (1987) study.

Acknowledgements-The

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Received September 3, 1991 Accepted December 18, 1991