Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Depressive attributional style and depression following childbirth Manly, Patricia Colleen 1981

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1981_A8 M29.pdf [ 2.9MB ]
Metadata
JSON: 831-1.0094990.json
JSON-LD: 831-1.0094990-ld.json
RDF/XML (Pretty): 831-1.0094990-rdf.xml
RDF/JSON: 831-1.0094990-rdf.json
Turtle: 831-1.0094990-turtle.txt
N-Triples: 831-1.0094990-rdf-ntriples.txt
Original Record: 831-1.0094990-source.json
Full Text
831-1.0094990-fulltext.txt
Citation
831-1.0094990.ris

Full Text

DEPRESSIVE ATTRIBUTIONS STYLE AND DEPRESSION FOLLOWING CHILDBIRTH by PATRICIA COLLEEN MANLY B.A., The Univ e r s i t y of Calgary, 1978 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES (Department of Psychology) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA October 1981 cj P a t r i c i a Colleen Manly, 1981 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e head o f my department o r by h i s o r h e r r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Department o f The U n i v e r s i t y o f B r i t i s h C o l u m b i a 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5 Date DE-6 (2/79) i i Abstract The reformulated learned helplessness model posits that individuals who make i n t e r n a l , stable and global attributions for undesired outcomes are more l i k e l y than others to become depressed when faced with important l i f e events that are perceived as uncontrollable. Seligman, Abramson, Semmel and von Baeyer (1979) found s i g n i f i c a n t correlations between a t t r i b u t i o n a l style and concurrent measures of depression i n a sample of college undergraduates. The purpose of the present study was to address two questions a r i s i n g from the Seligman et a l . study within the context of the event of c h i l d b i r t h . The f i r s t question was whether the r e l a t i o n -ship between depressive a t t r i b u t i o n a l style and concurrent depression found i n college undergraduates could be extended to women anticipating the b i r t h of t h e i r f i r s t c h i l d . The second question was whether depressive a t t r i b u -t i o n a l style would have predictive u t i l i t y with this group, that i s , whether women's prenatal a t t r i b u t i o n a l style would be predictive of de-pression i n the f i r s t week postpartum. The results provide neglible support for the notion of depressive a t t r i b u t i o n a l style as defined by the reformu-lated learned helplessness hypothesis. Although t h i s study was not designed to test hypotheses based upon any other model of depression, the findings were consistent with Beck's (1967) formulation. Several alternative explan-ations for the discrepancy between the present findings and those reported by Seligman et a l . are discussed. Notably, 17% of this r e l a t i v e l y homogeneous sample of primiparous"• ; women reported depression of c l i n i c a l severity during the f i r s t week postpartum. i i i Table of Contents Page Abstract i i L i s t of Tables i v Acknowledgements v Introduction 1 Method 10 Subjects 10 Measures 13 Procedure 15 Results 17 Prenatal Analyses 18 Postpartum Analyses 22 P a r t i a l Correlations 22 Mult i p l e Regression Analyses 22 Discriminant Analysis 25 Discussion - 28 Reference Notes 37 References 38 Appendix A: A t t r i b u t i o n a l Style Questionnaire 42 Appendix B: Beck Depression Inventory 50 Appendix C: Depression Adjective Check L i s t s 53 Appendix D: McLean-Hakstian Scale 56 IV L i s t of Tables Table 1 Percentages and medians of family income l e v e l for sub samples and f u l l sample - - - - 12 Table 2 Intercorrelations among a t t r i b u t i o n a l dimensions - - - - 19 Table 3 Comparisons of correlations of a t t r i -butional subscales with concurrent measures of depression - - - — 22 Table 4 P a r t i a l correlations between prenatal composite a t t r i b u t i o n a l scores and postpartum depression, co n t r o l l i n g for prenatal depression - - - - 23 Table 5 Sets of beta weights and multiple corre l a t i o n a l coefficients for each c r i t e r i o n variable - - - - 24 Table 6 C l a s s i f i c a t i o n by discriminant function 27 Acknowledgements I would l i k e to thank my thesis committee for t h e i r h e l p f u l guidance and suggestions: Dr. Robert J. McMahon (Supervisor), Dr. Tannis MacBeth Williams, and Dr. James Steiger. I would also l i k e to thank Jennifer Warnyca for administering the h o s p i t a l spot checks. Special thanks are due to Dr. C h r i s t i n e Bradley, Research Director of Project Prepare, without whose cooperation t h i s project would have been impossible. I am e s p e c i a l l y indebted to the l a t e Dr. Park 0. Davidson, who supervised the early stages of the t h e s i s , and who was Project Prepare's P r i n c i p a l Investigator at the time of h i s death. Park's support, guidance, arid advice were i n v a l u a b l e — w e a l l miss him. INTRODUCTION 1 According to the learned helplessness hypothesis, individuals experience motivational, cognitive, and affective d e f i c i t s when they come to expect that outcome i s independent of response. The o r i g i n a l model was based upon laboratory experiments, f i r s t with animal and la t e r with human subjects. Helplessness, or the expectation of noncontingency, was induced by exposing subjects to uncontrollable events. In human subjects, inescapable noise (eg. Hiroto, 1974) or unsolvable problems (eg. M i l l e r & Seligman, 1975) have been the most common experimental manipulations. Seligman and his colleagues ( M i l l e r , R o s e l l i n i , & Seligman, 1977; Seligman, 1975) have argued that the symptoms of laboratory induced helplessness p a r a l l e l those of human depression, and that the learned helplessness model can account for some forms of nonpsychotic depression. Studies with human subjects have changed i n focus from an early interest i n extending the findings of animal studies to a more recent emphasis upon theory building (Abramson, Seligman, & Teasdale, 1978). As these studies progressed, numerous inadequacies of the o r i g i n a l model became apparent.(for c r i t i q u e s , see Costello, 1978; Depue & Monroe, 1978). Abramson et a l . (1978) developed a reformulation of the learned helplessness hypothesis i n order to account for features of depression that the o r i g i n a l model could not adequately explain: the paradox of helplessness and self-blame often observed i n depression, the question of reduced self-esteem, and the problem of the generality and chronicity of helplessness d e f i c i t s . B r i e f l y , the reformulated model holds that when faced with uncontrollable events, individuals make attributions about the cause of unc o n t r o l l a b i l i t y . The model specifies three relevant a t t r i b u t i o n a l dimensions: internal-external, stable-unstable, and global-specific. Attributions are in t e r n a l to the extent that causes are attributed to the individ u a l rather than to other people or circumstances. Attributions 2 are stable to the extent that causal factors are expected to be long-lived or recurrent rather than s h o r t - l i v e d or intermittent. A t t r i b u t i o n s are global to the extent that causes are believed to a f f e c t a broad range of s i t u a t i o n s rather than a l i m i t e d set of circumstances. An i n d i v i d u a l who responds to f a i l u r e on a mathematics test by saying " I ' l l always be a f a i l u r e i n everything I do" exhibits rather extreme i n t e r n a l , stable, and global a t t r i b u t i o n s for the f a i l u r e . On the other hand, an i n d i v i d u a l who responds to a s i m i l a r s i t u a t i o n by saying "Some of the questions i n t h i s week's test were e x t r a o r d i n a r i l y d i f f i c u l t " exhibits external, unstable, and s p e c i f i c a t t r i b u t i o n s . The reformulated learned helplessness model holds that i n d i v i d u a l s who make i n t e r n a l a t t r i b u t i o n s for perceived noncontingency are l i k e l y to su f f e r d e f i c i t s of self-esteem, and to blame themselves for events they believe they cannot co n t r o l . I t i s also hypothesized that stable a t t r i b u t i o n s w i l l tend to extend the duration of d e f i c i t s over time, and that global a t t r i b u t i o n s are l i k e l y to r e s u l t i n the generalization of d e f i c i t s to a v a r i e t y of s i t u a t i o n s . Thus, the hypothesized depressive a t t r i b u t i o n a l s t y l e , c o n s i s t i n g of i n t e r n a l , stable, and global a t t r i b u t i o n s for undesired outcomes, i s posited to lead to an expectation of future noncontingency and thus to symptoms of helplessness. According to the model, i n d i v i d u a l s with t h i s type of a t t r i b u t i o n a l s t y l e are more l i k e l y to become depressed when faced with important l i f e events that are perceived as uncontrollable. Abramson et a l . (1978) further suggest that the model has preventative implications i n that i t may be possible to i d e n t i f y people who are depression-prone p r i o r to the a c t u a l onset of depression by assessing t h e i r a t t r i b u t i o n a l s t y l e . In a subsequent p u b l i c a t i o n , Seligman, Abramson, Semmel, and von Baeyer (1979) addressed themselves more s p e c i f i c a l l y to the notion of a depressive 3 a t t r i b u t i o n a l s t y l e . An a t t r i b u t i o n a l s t y l e questionnaire (Peterson, Semmel, von Baeyer, Abramson, Metalsky, & Seligman, Note 1) was developed to assess each of the three relevant a t t r i b u t i o n a l dimensions. The questionnaire y i e l d s scores for each dimension as well as a composite a t t r i b u t i o n a l score. The authors found that for hypothetical negative outcomes, i n t e r n a l , stable, global, and composite scores each correlated s i g n i f i c a n t l y with measures of depression i n a group of college undergraduates. Seligman et a l . (1979) concluded that t h e i r findings supported both the notion of a depressive a t t r i b u t i o n a l s t y l e and the reformulated learned helplessness model of depression. .They did point out that the "model predicts that the in s i d i o u s a t t r i b u t i o n a l s t y l e for bad outcomes does not by i t s e l f r e s u l t i n depression" (Seligman et a l . , 1979, p. 246), but that depression ensues when these types of a t t r i b u t i o n s are made for important l i f e events. Although not made e x p l i c i t by the authors, the assumption seems to be that the more strongly an i n d i v i d u a l exhibits t h i s a t t r i b u t i o n a l s t y l e for hypothetical s i t u a t i o n s , the more l i k e l y the i n d i v i d u a l i s to make s i m i l a r a t t r i b u t i o n s for important l i f e events, and thus the more l i k e l y to become depressed following such events. A number of questions a r i s e from the Seligman et a l . (1979) study. The most obvious, as pointed out by the authors, i s whether the r e s u l t s generalize to other populations. A second question i s to what extent a t t r i b u t i o n a l s t y l e , as assessed by the Peterson et a l . (Note 1) scale, has p r e d i c t i v e value i n i d e n t i f y i n g depression-prone i n d i v i d u a l s p r i o r to the onset of depression. As Seligman et a l . (1979) have noted, t h e i r study supports the hypothesis that depression and a t t r i b u t i o n a l s t y l e are r e l a t e d , at least i n college undergraduates, but does not inform us as to the d i r e c t i o n of the r e l a t i o n s h i p . I t may be i n t e r e s t i n g to examine whether in d i v i d u a l s i d e n t i f i e d as depression-prone according to t h e i r a t t r i b u t i o n a l 4 s t y l e are indeed more l i k e l y than others to become depressed following an important l i f e event. A major d i f f i c u l t y for the researcher, of course, i s the general u n p r e d i c t a b i l i t y of both the occurrence of such events and the onset of depression. C h i l d b i r t h i s one important l i f e event that i s reasonably predictable some months i n advance. Furthermore, i t would appear that many women do become depressed i n the postpartum period. Unfortunately, i t i s d i f f i c u l t , i f not impossible, to accurately assess j u s t how many women do su f f e r from depression following c h i l d b i r t h on the basis of the current l i t e r a t u r e . There does appear to be general agreement that postpartum depressive psychosis i s quite rare, with most estimates f a l l i n g below a rate of 1 i n 500 b i r t h s (eg., Grundy & Roberts, 1975; Herzog & Detre, 1976; P i t t , 1975; Pugh, Jerath, Schmidt, & Reed, 1963; Reich & Winokur, 1970). Studies of nonpsychotic forms of postpartum depression, to which the learned helplessness hypothesis i s more appropriately addressed, have yielded much more inconsistent findings. As a whole, t h i s p a r t i c u l a r body of l i t e r a t u r e has been plagued with serious methodological and conceptual d i f f i c u l t i e s which contribute to the confusion. In a recent review, Atkinson and R i c k e l (Note 2) pointed out that a) d e f i n i t i o n a l confusion, b) inadequate measurement, and c) the absence of an in t e g r a t i n g theory on which to base hypotheses have l i m i t e d the usefulness of much of the l i t e r a t u r e r e l a t e d to postpartum depression. The d e f i n i t i o n a l confusion i s evident i n the varying nomenclature and diagnostic c r i t e r i a that p r e v a i l i n the l i t e r a t u r e . Such terms as puerperal depression (Dalton, 1971), postpartum adjustment (Blumberg, 1980; Paschall & Newton, 1976; Sheehan, 1981), mental handicap (Uddenberg & Nilsson, 1975), mental i l l n e s s (Fondeur, Fixsen, T r i e b e l , & White, 1957), emotional d i f f i c u l t i e s (Zajicek & Wolkind, 1978) and postpartum emotional disorder 5 (Braverman & Roux, 1978) have been used to describe a multitude of maladies, a l l of which include depression but most of which have been assessed by measures of unknown r e l i a b i l i t y . As might be expected, estimates of the incidence of postpartum depression derived from such studies vary widely. Reviews of the l i t e r a t u r e have c i t e d incidence estimates ranging from as low as 3% ( c i t e d i n Martin, 1977: P i t t , 1968) to as high as 65% ( c i t e d i n P i t t , 1968) and 74% ( c i t e d i n Reich & Winokur, 1970), although most estimates tend to f a l l between 10 and 30% (eg., Braverman & Roux, 1978; Hayworth, L i t t l e , Bonham Carter, Raptopoulous, P r i e s t , & Sandler, 1980; Meares, Grimwade, & Wood, 1976; Paykel, Emms, Fletcher, & Rassaby, 1980; P i t t , 1968; Uddenburg & Englesson, 1978; Zajicek & Wolkind, 1978; Atkinson & R i c k e l , Note 2). The assorted d e f i n i t i o n s and measures used i n most of these studies severely l i m i t the comparability and conclusiveness of t h e i r findings. A handful of studies report incidence rates that are based on standardized measures of depression, but because of methodological problems, these estimates also vary more widely than might be expected. P i t t (1968) has used a p a r t i a l l y validated scale of h i s own design, for which he reported a t e s t - r e t e s t c o r r e l a t i o n of .76 ,(n=40) and a c o r r e l a t i o n of .78 (n=40) with judgments guided by the Hamilton Rating Scale for Depression. Using t h i s scale he found an incidence rate of 10.8%. However, since the scale has been used almost e x c l u s i v e l y by P i t t , and since i t i s designed to assess anxiety and depression together, i t i s d i f f i c u l t to compare his f i n d i n g to those of other researchers. Hayworth et a l . (1980) found that approximately 22% of t h e i r sample scored above the cut-off for mild depression on the Zung S e l f - r a t i n g Depression Scale at 6 weeks postpartum. The Beck Depression Inventory (BDI) (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), which has been described as the best of 6 current s e l f - r a t i n g scales of depression (Rehm, 1976; Riz l e y , 1978), has been employed i n four studies. Cut-offs for c l i n i c a l depression vary; however, Beck (1967) has recommended a score of 13 or 14 on the BDI as an appropriate cut-off for c l i n i c a l depression. Rees and Lutkins (1971) conducted the e a r l i e s t BDI study, but t h e i r small sample s i z e l i m i t s the g e n e r a l i z a b i l i t y of t h e i r findings. Bearing t h i s i n mind, of the 26 women assessed at 12 weeks postpartum, 26.9% scored 14 or higher on the BDI and 11.5% scored 17 or higher. Bradley (Note 3) employed the BDI as well as the Depression Adjective Check L i s t (DACL), but did not report the proportion of subjects who met the c r i t e r i o n for c l i n i c a l depression. Clarke and Williams (1979) employed the BDI to assess depression at 2 days, 6 weeks, and 6 months postpartum. For women who had had l i v e b i r t h s , the proportion scoring at or above 17 on the BDI was quite s i m i l a r at each point of assessment, ranging from 3.3% to 5.1%. As the authors pointed out, however, "many of the women with high i n i t i a l depression scores f a i l e d to return further questionnaires despite several attempts to contact them .... It thus seems l i k e l y that our estimates of depression are lower than the true prevalence" (Clarke & Williams, 1979, p. 917). A t h i r d study (Atkinson & R i c k e l , Note 2) reported that at 8 weeks postpartum, 26% of t h e i r sample (n=78) scored above the cut-off recommended by Beck (1967). Given the d i s p a r i t y i n the findings of these studies, i t seems c r i t i c a l that researchers take p a r t i c u l a r care i n future studies to provide d e t a i l e d descriptions of the c h a r a c t e r i s t i c s of t h e i r sample. In only one of the studies reviewed (Atkinson & R i c k e l , Note 2) was the incidence of depression assessed by means of multiple c r i t e r i a . I t would seem that any w e l l -designed study using multiple standardized measures of depression would provide a useful contribution to t h i s body of l i t e r a t u r e . In any case, while r e l i a b l e incidence rates remain to be established e m p i r i c a l l y , i t 7 would appear that a sizeable minority of women i s vulnerable to depression following c h i l d b i r t h . Although onset of postpartum depression has been reported to occur at any time during the puerperium (eg., Vandenbergh, 1980), several observers have reported that a frequent time of onset i s during the t h i r d or fourth day postpartum (eg., Dalton, 1971; Yalom, Lunde, Moos, & Hamburg, 1968). Systematic prospective studies of time of onset are generally lacking; however Bradly (Note 3) found that depression, as measured by DACL, tended to peak on the t h i r d day following c h i l d b i r t h . Since t h i s point i n time corresponds to a precipitous drop i n hormone l e v e l s , notably estrogen and progesterone, several observers (eg., Dalton, 1971; Meares et a l . , 1976; Paykel et a l . , 1980; Vandenbergh, 1980) have at t r i b u t e d depression that occurs following c h i l d b i r t h to hormonal causes. Despite the temporal contiguity, there are several arguments that would suggest that the hormonal hypothesis i s less than adequate as an explanation of postpartum depression. Reviewers (Gelder, 1978; Steiner, 1979) have reported that p h y s i o l o g i c a l evidence of a r e l a t i o n s h i p between hormone le v e l s and postpartum depression i s inconsistent at best. Upon reviewing the a v a i l a b l e p h y s i o l o g i c a l evidence, Gelder (1978) characterized hypotheses of hormonal etiology of postpartum depression as "mere speculation" (p. 86), and suggested that the evidence that p h y s i o l o g i c a l changes are the causes of longer l i v e d forms of postpartum depression i s even weaker. These reviewers also pointed out that depression does not nec e s s a r i l y subside when hormone leve l s return to normal. In a multiple regression analysis, Paykel et a l . (1980) found that early postpartum blues was a s i g n i f i c a n t predictor of depression assessed at 6 weeks postpartum. F i n a l l y , the hormonal hypotheses do not explain why only a minority of women experience depression of c l i n i c a l s e verity following c h i l d b i r t h when presumably a l l women experience a change 8 i n hormones. I t would appear, then, that despite the r e l a t i v e l y frequent onset of depression i n the f i r s t week postpartum, the hormonal hypothesis i s i n s u f f i c i e n t to explain postpartum depression, and other hypotheses should be entertained. Several authors (eg., Fondeur et a l . , 1957; Paykel et a l . , 1980; P i t t , 1975; Reich & Winokur, 1970) have noted that postpartum depression c l o s e l y resembles depression occurring i n other circumstances. Atkinson and R i c k e l (Note 2) have suggested that hypotheses derived from more general models of depression may be useful i n guiding research r e l a t e d to depression following c h i l d b i r t h . The learned helplessness hypothesis i s one such model that has been suggested as possibly applicable to postpartum depression (Hayworth et a l . , 1980). The notion of perceived c o n t r o l , which i s c e n t r a l to the notion of learned helplessness (Abramson et a l . , 1978; Seligman, 1975), has been frequently noted as an important v a r i a b l e i n terms of both the psychological and o b s t e t r i c a l outcome of pregnancy and c h i l d b i r t h (eg. Charles, Norr, Block, Meyering, & Meyers, 1978; Felton & Segelman, 1978; Hayworth et a l . , 1980; Seiden, 1976). The reformulated learned helplessness hypothesis (Abramson et a l . , 1978; Seligman, 1979) has the advantage of providing s p e c i f i c predictions regarding the i d e n t i f i c a t i o n of i n d i v i d u a l s who may be vulnerable to depression p r i o r to i t s onset. According to t h i s model, one would expect women who demonstrate the depressive a t t r i b u t i o n a l s t y l e of i n t e r n a l , stable, and global a t t r i b u t i o n s for negative events to be e s p e c i a l l y vulnerable to depression following an important l i f e event such as c h i l d b i r t h . To conclude, a p p l i c a t i o n of the reformulated learned helplessness hypothesis to postpartum depression would seem to be appropriate from two points of view. F i r s t , studies of postpartum depression have suffered 9 from the absence of an integrating model of depression from which research hypotheses may be generated. The reformulated learned helplessness hypothesis provides such a model. Second, and more importantly, an examination of depression following c h i l d b i r t h may provide a unique opportunity to address questions a r i s i n g from the Seligman et a l . (1979) study, since c h i l d b i r t h i s a r e l a t i v e l y predictable event which does appear to be followed by depression i n some cases. Not only do pregnant women represent a group for whom depression i s a relevant issue, then, but i t i s also possible to examine the predictive u t i l i t y of depressive a t t r i b u t i o n a l style for th i s group. I t would be interesting to ascertain whether women i d e n t i f i e d prenatally as depression-prone, according to their a t t r i b u t i o n a l s t y l e , are more lik e l y . t h a n others to show elevated depression scores following c h i l d b i r t h . The purpose of the present study was to examine whether certain predictions of the reformulated learned helplessness model can be applied to individuals experiencing a part i c u l a r l i f e event, v i z . c h i l d b i r t h . More s p e c i f i c a l l y , the present study endeavoured to address two questions a r i s i n g from the Seligman et a l . (1979) study within tha context of the event of c h i l d b i r t h . The f i r s t question i s whether the relationship between depressive a t t r i b u t i o n a l style and concurrent depression found i n college undergraduates can be extended to women anticipating the b i r t h of their f i r s t c h i l d . The second question i s whether depressive a t t r i b u t i o n a l style has predictive u t i l i t y with this group, that i s , whether women's prenatal a t t r i b u t i o n a l style i s predictive df depression i n the f i r s t week postpartum. To address these questions, data were collected at two points i n time. The At t r i b u t i o n a l Style Questionnaire (Peterson et a l . , Note 1) and three measures df depression were administered concurrently during the t h i r d trimester of pregnancy, and the three 10 depression measures were administered again on the t h i r d day postpartum. Method Subjects The subjects f o r t h i s study were drawn from those r e c r u i t e d by Project Prepare. Project Prepare i s a long-term i n v e s t i g a t i o n of the antecedents and consequences of parental adaptation during pregnancy and the postpartum period, and i s funded by Health and Welfare Canada. The Project has co l l e c t e d data from over 300 unpaid volunteers since i t s inception i n 1979. A l l subjects were re c r u i t e d from prenatal classes conducted by the Vancouver Health Department or private organizations. To be e l i g i b l e for recruitment by Project Prepare, subjects were required to be primiparous, no more than 26 weeks gravid, fluent i n English, and residents of Vancouver, Burnaby, or Richmond. The target group for the present study consisted of those Project Prepare subjects whose del i v e r y due date occurred between October 1, 1980 and February 4, 1981, i n c l u s i v e . Eighty-eight (88) women met t h i s c r i t e r i o n . Of these 88 women, questionnaires were administered to 65. The other 23 women were excluded from the sample for various reasons: 3 had been h o s p i t a l i z e d early due to medical complications, 4 had moved and could not be located, 4 had dropped out of Project Prepare due to language d i f f i c u l t i e s (n=l) or for personal reasons (n=3), and 12 had completed Project Prepare's t h i r d trimester package p r i o r to the t h i r t y - f i f t h week of pregnancy. Of the 65 women who were s u c c e s s f u l l y contacted, 4 subjects did not complete the A t t r i b u t i o n a l Style Questionnaire, and were therefore not included i n the analyses. Two of these women subsequently dropped from Project Prepare. For 11 of the remaining 61 subjects, postpartum measures were unavailable for various reasons, including medical complications 11 while i n h o s p i t a l (n=4), packages apparently l o s t or delayed i n the mail (n_=3), early discharge from h o s p i t a l ( n = l ) , a lengthy delay i n returning the h o s p i t a l questionnaires (n= 1), and termination by Project Prepare because of either language d i f f i c u l t i e s (n= 1) or chronic f a i l u r e to return questionnaire packages (_n= 1). In sum, a t o t a l of 50 women completed both sets of questionnaires. A t t r i b u t i o n a l measures and concurrent measures of prenatal depression were a v a i l a b l e for 61 subjects. Demographic data were unavailable for one of the subjects who completed both sets of data. Those 11 subjects who did not submit h o s p i t a l data were compared with those 49 who completed both sets of questionnaires and for whom demographic data were a v a i l a b l e . The two groups were not s i g n i f i c a n t l y d i f f e r e n t with respect to age, _t(58) = .0308, j> > .05, or education, x 2 ( l ) = -1360, j>> .05. The o v e r a l l mean age was 28.5 years (n=60). Of these 60 subjects, 11 had not proceeded beyond high school, 22 had one or two years of post-secondary education, 22 had graduated from u n i v e r s i t y , and 5 had pursued post-graduate education. The two groups did d i f f e r s i g n i f i c a n t l y with respect to income l e v e l , X 2(1) =4.5172, _p_< .05. The majority of those subjects who completed both sets of data had family incomes that exceeded $30,000, while most subjects who did not submit h o s p i t a l data had family earnings of $20,000 or l e s s . Considering the complete sample (n=60), family income exceeded $30,000 for the majority of subjects. Percentages and medians for income categories are summarized i n Table 1. The two subsamples also d i f f e r e d with respect to m a r i t a l status, i n that a greater proportion of women i n the smaller subsample were" without partners. This proportional d i f f e r e n c e was s t a t i s t i c a l l y s i g n i f i c a n t (j>< .03). Two women (18%) i n the smaller subsample (n= 11) were s i n g l e , whereas only one woman (2%) i n the larger subsample (n= 49) was si n g l e . 12 Table 1 Percentages and Medians of Family Income Level for Subsamples and F u l l Sample Percentages within Subsamples Income Annual Hospital Data No Hospital F u l l Level Income Submitted Data Submitted Sample 4 $30,000 59 18 52 3 21,000 - 30,000 16 27 18 2 10,000 - 20,000 21 46 25 1 $10,000 4 9 5 Totals 100 (n=49) 100 (n=ll) 100 (n=60) Median Income Level 3.66 2.25 3.53 13 Considering only those women who were married or l i v i n g with t h e i r partners, the two subsamples did not d i f f e r s i g n i f i c a n t l y with respect to the number of years married or l i v i n g together, _t(55) = .6146. The mean duration of cohabitation was 4.23 years (n.= 57). Measures Four s e l f - r e p o r t measures were employed: an A t t r i b u t i o n a l Style Questionnaire, and three measures of depression. The A t t r i b u t i o n a l Style Questionnaire (Peterson et a l . , Note 1) was used by Seligman et a l . (1979) i n t h e i r study of a t t r i b u t i o n a l s t y l e and concurrent depression. The questionnaire consists of 12 hypothetical s i t u a t i o n s , s i x describing p o s i t i v e outcomes and s i x describing negative outcomes. For each s i t u a t i o n , subjects are asked to name a major cause and to rate the cause for degree of i n t e r n a l i t y , s t a b i l i t y , g l o b a l i t y , and importance of the s i t u a t i o n i f i t were to happen to them (see Appendix A for sample). For each type of outcome (p o s i t i v e or negative), four a t t r i b u t i o n a l scores can be calcu l a t e d : i n t e r n a l i t y , s t a b i l i t y , g l o b a l i t y , and a composite a t t r i b u t i o n a l score, which i s the sum of the scores on the three a t t r i b u t i o n a l subscales. A measure o f the importance of both negative and p o s i t i v e events can also be derived from the questionnaire although no psychometric information i s a v a i l a b l e for these subscales. Thus a t o t a l of 10 subscales can be generated from the questionnaire. Peterson et a l . (Note 1) have reported r e l i a b i l i t y figures for the eight a t t r i b u t i o n a l subscales. Internal consistency was estimated by means of Cronbach's c o e f f i c i e n t alpha. For the composite a t t r i b u t i o n a l scores, alpha c o e f f i c i e n t s of .75 for p o s i t i v e outcomes and .72 for negative outcomes were obtained. For the s i x a t t r i b u t i o n a l dimensions, c o e f f i c i e n t s were lower, ranging from .44 to .69, with a mean of .54. 14 Test-retest r e l i a b i l i t y was based on a 5-week i n t e r v a l with a sample of 100 subjects. Correlations ranged from .57 to .70, and a l l were s t a t i s -t i c a l l y s i g n i f i c a n t (p_> .001). Peterson et a l . note that d i s c r i m i n a t i o n among the i n d i v i d u a l dimensions was low, as r e f l e c t e d i n the s i g n i f i c a n t l y p o s i t i v e c o r r e l a t i o n s among the a t t r i b u t i o n a l dimensions for p o s i t i v e and negative outcomes, r e s p e c t i v e l y . Although the questionnaire i s being revised, the r e v i s i o n was not a v a i l a b l e at the time the present study was conducted. In order to render the A t t r i b u t i o n a l Style Questionnaire more appropriate to the present sample, the wording of two items was changed s l i g h t l y . "Your spouse ( b o y f r i e n d / g i r l f r i e n d ) has been t r e a t i n g you more l o v i n g l y " was changed to "Your spouse (partner) has been t r e a t i n g you more l o v i n g l y , " i n order to correspond to the wording used by Project Prepare. "You go out on a date and i t goes badly" was changed to read "You go out for the evening and i t goes badly." The measures of self-reported depression used i n t h i s study include a) the Beck Depression Inventory (BDI) (Beck e t . a l . , 1961); b) the Depression Adjective Check L i s t , forms B and E (DACL B and DACL E) (Lubin, 1965); and c) a depression scale developed by McLean and Hakstian (Note 4). The BDI (Beck et a l . , 1961) i s an e a s i l y administered, r e l a t i v e l y well-validated measure of the number and severity of depressive symptoms, and has been used extensively i n learned helplessness studies (e.g., Rizley, 1978; Seligman et a l . , 1979). The BDI correlates s i g n i f i c a n t l y with other measures of depression, including p s y c h i a t r i s t s ' ratings (e.g., Beck et a l . , 1961), the Hamilton Rating Scale (Williams, Barlow, & Agras, 1972), observational measures of depressive behaviour (Williams et a l . , 1972), the DACL (e.g., Lubin, 1967), and the MMPI D-scale and Zung's 15 r a t i n g scale (cited i n Rehm, 1976). Estimates of i n t e r n a l consistency are high, with an odd-even item c o r r e l a t i o n of .86 (Beck et a l . , 1961). Rehm (1976) c i t e s t e s t - r e t e s t c o r r e l a t i o n s of .75 and .74 for 1-month and 3-month i n t e r v a l s , r e s p e c t i v e l y . For the purposes of the present study, the item on the BDI related to recent weight loss was omitted. The BDI i s presented i n Appendix B. The DACL was developed as a measure of transient depressive mood, as part of "an i n v e s t i g a t i o n of mood changes during pregnancy and the postpartum period" (Lubin, 1965, p. 57). The DACL B and DACL E have been found to c o r r e l a t e highly with one another (r_= .89) and with the MAACL Depression Scale (r_ = .87 and r_= .80, respectively) (Lubin, 1967). A l l forms of the DACL c o r r e l a t e s i g n i f i c a n t l y with other measures of depression, including the MMPI D-scale, the BDI, Zung's S e l f - r a t i n g Depression Scale, and p s y c h i a t r i s t s ' r atings, for both normal and c l i n i c samples (Lubin, 1976). As would be expected with a measure of transient mood, t e s t - r e t e s t r e l i a b i l i t y i s quite low, ranging from .19 to .24 (Lubin & Himmelstein, 1976). Estimates of i n t e r n a l consistency are a l l high, ranging from .84 to .93 (Lubin, 1967). The DACL B and DACL E are presented i n Appendix C. The McLean and Hakstian depression scale i s a 4-item, behaviourally anchored questionnaire. It has been demonstrated to have a h i t rate of approximately 95% i n discriminating between depressed inpatients and normals i n a double c r o s s - v a l i d a t i o n study (McLean & Hakstian, Note 4). R e l i a b i l i t y and v a l i d i t y figures are currently i n preparation. The McLean-Hakstian Scale i s presented i n Appendix D. Procedure Subjects were rec r u i t e d from prenatal classes by a community health nurse. Subsequently, an interview was conducted by a nurse i n the subject's 16 home, at which time the general requirements of p a r t i c i p a t i o n i n the study were explained and consent forms were completed. Each subject was assigned a code number to ensure c o n f i d e n t i a l i t y . During the t h i r t y - t h i r d and t h i r t y - f o u r t h week of pregnancy, each subject was telephoned to arrange a time within the following weeks when i t would be convenient for her to complete the prenatal measures. Prenatal measures included the A t t r i b u t i o n a l Style Questionnaire, the BDI, the DACL B, and the McLean-Hakstian scale. These four questionnaires took approximately 50 minutes to complete. The prenatal measures were delivered by the researcher to each subject at her home at the pre-arranged time. To approximate the procedure reported by Seligman et a l . (1979), the researcher was not present when the measures were being completed. Subjects were t o l d that the researcher would return i n approximately 1 hour to c o l l e c t the completed questionnaires. Subjects were instructed to place the completed questionnaires i n an envelope provided by the researcher, and to seal the envelope before the researcher's return. The three depression measures were administered again postpartum, but the DACL E was substituted for the DACL B. The postpartum measures were included with Project Prepare's h o s p i t a l questionnaires, which were mailed to each subject during the f i n a l month of pregnancy. A covering l e t t e r explained when the questionnaires were to be completed. Subjects took :: t h i s packet of questionnaires with them when they went to the h o s p i t a l . Questionnaires for Project Prepare were completed during each day of the h o s p i t a l stay. The questionnaires for the present study were each marked "DAY 3," and were completed on the t h i r d day postpartum. In order to minimize p h y s i o l o g i c a l v a r i a t i o n , the questionnaires were administered on 17 the same day postpartum for each subject. Day 3 was chosen since i t i s a frequent time of onset for postpartum depression. The nursing researcher for Project Prepare monitored the completion of the h o s p i t a l questionnaires on an intermittent basis to ensure that they were being completed on the appropriate day. The h o s p i t a l questionnaires were returned by mail i n postage prepaid envelopes. Results Two general research issues were addressed i n the data a n a l y s i s . The f i r s t involved the extent to which c o r r e l a t i o n s i n the present sample corresponded to those reported by the Univ e r s i t y of Pennsylvania group (Seligman et a l . , 1979; Peterson et a l . , Note 1). I n t e r c o r r e l a t i o n s among the s i x a t t r i b u t i o n a l dimensions were compared to those reported by Peterson et a l . (Note 1), and co r r e l a t i o n s of a t t r i b u t i o n a l s t y l e with concurrent measures of depression were compared to those reported by Seligman et a l . (1979). Both sets of comparisons were ca r r i e d out using the f u l l prenatal sample (n= 61). The second general issue was to assess the u t i l i t y of depressive a t t r i b u t i o n a l s t y l e i n pr e d i c t i n g early postpartum depression, using data from the women for whom both prenatal and postpartum data were a v a i l a b l e (n=50). Six p a r t i a l c o r r e l a t i o n s , three step-wise multiple regression analyses, and a step-wise discriminant analysis were conducted. The p a r t i a l c o r r e l a t i o n s were conducted since l i n e a r dependencies would have been set up within the data matrices had the composite a t t r i b u t i o n a l scores been included i n the other four analyses. The two composite a t t r i b u t i o n a l scores were correlated with each of the three postpartum depression measures, with prenatal depression p a r t i a l l e d out i n each case. Each multiple regression analysis used one of the postpartum measures of 18 depression as the c r i t e r i o n v a r i a b l e . In each case, the predictor variables included: a) the prenatal depression measure which corresponded to the c r i t e r i o n measure, and b) the s i x a t t r i b u t i o n a l dimension scores and the two importance scores from the A t t r i b u t i o n a l Style Questionnaire (Peterson et a l . , Note 1). Predictor v a r i a b l e s for the discriminant analysis included a l l three prenatal depression measures, as well as the si x a t t r i b u t i o n a l dimension scores and two importance scores. For t h i s a n alysis, women were c l a s s i f i e d as depressed i f they met the cut-off for c l i n i c a l depression on two of the three postpartum measures. Degrees of freedom vary s l i g h t l y from one analysis to another, since subjects with missing data for any analysis were excluded from that a n a l y s i s . Prenatal Analyses The f i r s t group of analyses was conducted to compare c o r r e l a t i o n s reported by Peterson et a l . (Note 1) and Seligman et a l . (1979) with those from the present sample. Peterson et a l . reported i n t e r c o r r e l a t i o n s among the s i x a t t r i b u t i o n a l dimensions ranging from .18 to .45 among the a t t r i b u t i o n s for negative events (p_< .05), from .36 to 62 among the a t t r i b u t i o n s for p o s i t i v e events (p_< .05), and from -.17 (n.s.) to .24 ( J D < .05) when c o r r e l a t i n g negative with p o s i t i v e a t t r i b u t i o n a l dimensions. The findings for the present sample, as summarized i n Table 2, were very s i m i l a r . Individual c o r r e l a t i o n s ranged from .16 (n.s.) to .43 (p_< .001) among the negative a t t r i b u t i o n a l dimensions, from .30 to .41 among the p o s i t i v e a t t r i b u t i o n a l dimensions (p_< .01), and from -.22 (_p_< .05) to .15 (n.s.) when c o r r e l a t i n g negative with p o s i t i v e dimensions. For t h i s c l u s t e r of s i g n i f i c a n c e t e s t s , the cluster-wise error rate was set at a—.05. Using the Bonferroni procedure (Larzelere & Mulaik, 1977) the Table 2 In t e r c o r r e l a t i o n s Among A t t r i b u t i o n a l Dimensions Negative Outcomes Pos i t i v e Outcomes I n t e r n a l i t y S t a b i l i t y G l o b a l i t y I n t e r n a l i t y S t a b i l i t y G l o b a l i t y Negative Outcomes I n t e r n a l i t y S t a b i l i t y .16 G l o b a l i t y .43*** .23* P o s i t i v e Outcomes I n t e r n a l i t y -.15 -.22* -.08 S t a b i l i t y -.23* -.08 -.20 .31** G l o b a l i t y -.01 .02 .15 ,41*** .30** * £<.05 ** £<.01 ***p<. 001 20 c r i t i c a l s i g n i f i c a n c e l e v e l for each i n d i v i d u a l c o r r e l a t i o n was computed as .05/15= .0033. Only two of the c o r r e l a t i o n s (negative i n t e r n a l i t y with negative g l o b a l i t y and p o s i t i v e i n t e r n a l i t y with p o s i t i v e g l o b a l i t y ) met t h i s c r i t e r i o n for s i g n i f i c a n c e . The standard test (using the Fisher transformation) of the differ e n c e between independent c o r r e l a t i o n s was calculated_to compare the c o r r e l a t i o n s from the present study with the findings of Peterson et a l . Since none of the _p_ values f e l l below the c r i t i c a l l e v e l of .0033, the hypothesis of no s i g n i f i c a n t differences between the two samples cannot be rejected. Seligman et a l . (1979) reported s i g n i f i c a n t c o r r e l a t i o n s between a t t r i b u t i o n a l s t y l e for negative outcomes and concurrent measures of depression, ranging from .34 (p_< .001) to .48 (_p_< .00001) for the BDI and from .16 (p_< .07) to .24 (p_< .01) for the Adjective Check L i s t . For p o s i t i v e outcomes, c o r r e l a t i o n s between a t t r i b u t i o n s and depression were lower, ranging from -.09 (n.s.) to -.28 (_p< .002). In the present sample, co r r e l a t i o n s between a t t r i b u t i o n and depression showed quite a d i f f e r e n t pattern for^, negative outcomes, ranging from -.10 to .10 for both measures of depression ( a l l c o r r e l a t i o n s n o n s i g n i f i c a n t ) . Correlations for p o s i t i v e outcome a t t r i b u t i o n s were more s i m i l a r to those reported by Seligman et a l . and ranged from .14 (n.s.) to -.23 (p_= .040). The l a t t e r c o r r e l a t i o n (r_=-.23) was the only i n d i v i d u a l c o r r e l a t i o n i n the present analysis to reach s t a t i s t i c a l s i g n i f i c a n c e . When cluster-wise error was taken into account by means of the Bonferroni procedure (Larzelere & Mulaik, 1977), however, none of the c o r r e l a t i o n s i n the present c l u s t e r met the c r i t i c a l l e v e l of _p_< .0031 (a = .05/16 = .0031). The standard test (using the Fisher transformation) of the differ e n c e between independent c o r r e l a t i o n s was calculated to compare the present c o r r e l a t i o n s with those reported by 21 Seligman et a l . , and i n d i v i d u a l s i g n i f i c a n c e values are reported i n Table 3. The cluster-wise error rate was set at a = .05, and the c r i t i c a l s i g n i f i c a n c e l e v e l for each i n d i v i d u a l comparison was computed as .05/16= .0031. Since none of the J D values f e l l below t h i s l e v e l , the hypothesis of no s i g n i f i c a n t differences between the two samples cannot be rejected. Postpartum Analyses A t o t a l of 19 spot checks were conducted to ensure that the postpartum measures were being completed on the appropriate day. Only one of the 19 was found to be off schedule. This woman was among the 11 who f a i l e d to submit any h o s p i t a l data. The other 18 were among the 50 subjects who completed both sets of questionnaires. Several analyses were conducted to assess the p r e d i c t i v e u t i l i t y of depressive a t t r i b u t i o n a l s t y l e . P a r t i a l Correlations. The p a r t i a l c o r r e l a t i o n s between prenatal composite a t t r i b u t i o n a l s t y l e and postpartum depression are summarized i n Table 4. For each of the c r i t e r i o n v a r i a b l e s , the corresponding prenatal depression measure has been.partialled out. The p a r t i a l c o r r e l a t i o n s ranged from -.21 to .11, and none of them reached s t a t i s t i c a l s i g n i f i c a n c e . M u l t i p l e Regression Analyses. The f i n a l step of each of the three step-wise multiple regression analyses i s summarized i n Table 5. For each of the three analyses, s i g n i f i c a n c e tests were ca r r i e d out on the o v e r a l l multiple c o r r e l a t i o n c o e f f i c i e n t and on each of the beta weights. Given the r e l a t i v e l y small sample s i z e , an adjusted R 2 was calculated as a more conservative estimate of the variance accounted for by the regression equation. Adjusted R 2 i s an R 2 s t a t i s t i c adjusted for shrinkage. The multiple regression analysis which used the DACL as c r i t e r i o n f a i l e d to Table 3 Comparisons of Correlations of A t t r i b u t i o n a l Subscales with Concurrent Measures of Depression Beck Inventory Adjective Check L i s t A t t r i b u t i o n a l Subscale Seligman et a l . a (1979) findings Present findings Significance l e v e l of difference Seligman et a l . (1979) findings d Present findings Significance l e v e l of differe n c e Negative Outcomes I n t e r n a l i t y .41 . 10 n.s. . 18 .00 n.s. S t a b i l i t y .34 -.03 £ < .04 .18 -.10 n.s. G l o b a l i t y .35 .10 n.s. .16 .01 n.s. Composite .48 .09 £ < .02 .24 -.03 n.s. P o s i t i v e Outcomes I n t e r n a l i t y -.22 .04 n.s. -.05 .05 n.s. S t a b i l i t y -.28 -.09 n.s. -.09 -.23 n.s. G l o b a l i t y -.04 .14 n.s. -.04 -.01 n.s. Composite -.22 .05 n.s. -.11 -.07 n.s. Note: S i g n i f i c a n c e l e v e l s r e f e r to the s i g n i f i c a n c e of the difference between independent c o r r e l a t i o n s . a short form BDI b f u l l BDI C MAACL D-scale d DACL B Table 4 P a r t i a l Correlations Between Prenatal Composite A t t r i b u t i o n a l Scores and Postpartum Depression, C o n t r o l l i n g for Prenatal Depression Postpartum C r i t e r i o n Variables Composite A t t r i b u t i o n a l Scores BDI a DACL b McL-HC Negative Outcomes -.06 -11 -.08 Po s i t i v e Outcomes -.21 -.01 -.10 Note: None of the p a r t i a l c o r r e l a t i o n s wasv s t a t i s t i c a l l y s i g n i f i c a n t Prenatal BDI (Beck Depression Inventory) p a r t i a l l e d out, df=41. ^Prenatal DACL (Depression Adjective Check L i s t ) p a r t i a l l e d out, df=47 c Prenatal McL-H (McLean-Hakstian scale) p a r t i a l l e d out, df=39. Table 5 Sets of Beta Weights and Mult i p l e C o r r e l a t i o n a l Coefficients for Each C r i t e r i o n Variable Beta Weights for Predictors a ' C r i t e r i o n Multiple Adjusted Prenatal Negative Outcome Attributions Positive Outcome A t t r i b u t i o n s Depression Variable R R" Measure Internal Stable Global Importance Internal Stable Global Importance DACLb .44 .01 .11 .19 -.17 .06 .23 .05 .04 -.18 .14 BDI C .64** .27 .47*** .17 _,40*** -.06 .07 T.24 n.s. -.09 .05 McL-Hd .69*** .32 ,57*** .04 -.30* -.21 .45* .08 -.24 -.09 -.10 3. In each case, the prenatal depression •DACL = Depression Adjective Check L i s t measure i s that measure which corresponds to the c r i t e r i o n measure. c BDI = Beck Depression Inventory d McL-H = McLean - Hakstian *p_<.05 **£<. 02 ***p<.01 25 reach s t a t i s t i c a l s i g n i f i c a n c e (R= .44), suggesting that the present measures are poor predictors of t h i s measure of transient depressive mood. An adjusted R 2 of .01 was obtained for t h i s a n a l y s i s . Both of the other two analyses yielded s i g n i f i c a n t multiple c o r r e l a t i o n c o e f f i c i e n t s , with R= .64 (_p< .02), adjusted R 2 = .27, when using the Beck Inventory as c r i t e r i o n and R= .69 (p_< .01), adjusted R 2 = .32, for the McLean-Hakstian scale. Examination of the beta weights shows a s i m i l a r pattern f o r both analyses. In both cases, the prenatal depression measure was the best predictor, with Ji= .47 (_p_< .01) when using the BDI and Ji= .57 (p_< .01) with the McLean-Hakstian scale. A t t r i b u t i o n a l s t a b i l i t y for negative outcomes was also a s i g n i f i c a n t predictor i n both analyses, with B=-.40 (p_< .01) for the BDI as c r i t e r i o n and .B=-.30 (_p_< .05) for the McLean-Hakstian scale. For the analysis c a r r i e d out using the McLean-Hakstian as c r i t e r i o n , a t h i r d predictor v a r i a b l e , importance of negative outcomes, reached s t a t i s t i c a l s i g n i f i c a n c e (B= .45, _p_< -05). None of the other beta weights i n any of the multiple regression analyses was found to d i f f e r s i g n i f i c a n t l y from zero. Discriminant Analysis. A step-wise discriminant analysis was conducted to determine whether women c l a s s i f i e d as depressed during the f i r s t week postpartum could be d i f f e r e n t i a t e d from other women i n the sample on the basis of prenatal depressive a t t r i b u t i o n a l s t y l e . A l l prenatal measures, with the exception of the composite a t t r i b u t i o n a l scores, were included among the possible discriminating v a r i a b l e s . Women were c l a s s i f i e d as depressed or non-depressed according to the following c r i t e r i o n : A subject was required to score at or above the cut-off for c l i n i c a l depression on two of the three postpartum measures i n order to be •c l a s s i f i e d as depressed. For the DACL, the cut-off was set at two standard 26 deviations above the means reported by Lubin (1967), that i s , at a T-score of 70. Since Beck (1967, p. 203) suggests that a cut-off point at 13 or 14 on the Depression Inventory d i f f e r e n t i a t e s depressed from non-depressed patients, the cut-off for the present analysis was set at 14. McLean and Hakstian (Note 4) found that a score of 32 or higher e f f e c t i v e l y c l a s s i f i e d depressed patients; t h i s was used as the cut-off i n the present a n a l y s i s . Any instances of missing data on a c r i t e r i o n v a r i a b l e were considered to f a l l below the cut-off for depression on that v a r i a b l e . Three subjects had missing data on at l e a s t one of the d i s c r i m i n a t i n g v a r i a b l e s , and were thus eliminated from the analysis. In a l l , 47 women were c l a s s i f i e d according to the c r i t e r i o n described above. Eight (17%) were c l a s s i f i e d as depressed and 39 (83%) as non-depressed. Three of the predictor v a r i a b l e s made a s i g n i f i c a n t contribution to the discriminant function. Using standardized c o e f f i c i e n t s , the discriminant function i s D = .8022 $i + .7955 X 2 - .4123 X 3 where X^  = prenatal BDI, X 2 = importance of negative events, and X3 = a t t r i b u t i o n a l g l o b a l i t y for p o s i t i v e events. The equation, tested for s i g n i f i c a n c e , yielded a s i g n i f i c a n t F_ r a t i o , F(3,42) = 3.82, £ < .02. The discriminant function was used to c l a s s i f y the subjects into predicted depressed and non-depressed categories, as summarized i n Table 6. The proportion of correct c l a s s i f i c a t i o n s , including both v a l i d p o s i t i v e s and v a l i d negatives, i s .723. Of those eight subjects who met the c r i t e r i o n for c l i n i c a l depression, seven (87.5%) were c l a s s i f i e d c o r r e c t l y by discriminant function scores. Table 6 C l a s s i f i c a t i o n by Discriminant Function Predicted Group Membership Actual Group Non-depressed Depressed Totals Non-depressed' 27 (.575) 12 (.255) 39 (.830) Depressed 1 (.021) 7 (.149) 8 (.170) Totals 28 (.596) 19 (.404) 47 (1.00) Note: Figures i n parentheses r e f e r to the proportion of the t o t a l sample represented by each c e l l . 28 Discussion In general terms, the purpose of the present study was to assess the extent to which c e r t a i n predictions of the reformulated learned helplessness hypothesis (Abramson et a l . , 1978; Seligman et a l . , 1979) could be applied to women a n t i c i p a t i n g the b i r t h of t h e i r f i r s t c h i l d . The r e s u l t s provide n e g l i g i b l e support for the hypothesis, both i n terms of concurrent c o r r e l a t i o n s of a t t r i b u t i o n and depression and i n terms of the pr e d i c t i v e u t i l i t y of a t t r i b u t i o n a l s t y l e with t h i s group. In the present sample, the magnitude of i n t e r c o r r e l a t i o n s among a t t r i b u t i o n a l dimensions did not d i f f e r s u b s t a n t i a l l y from those reported by Peterson et a l . (Note 1), and do not present any challenge to the hypothesis that Peterson et a l . ' s findings can be generalized to the present sample. The co r r e l a t i o n s obtained between a t t r i b u t i o n a l s t y l e and concurrent measures of depression, however, seem to o f f e r a greater challenge to the g e n e r a l i z a b i l i t y of depressive a t t r i b u t i o n a l s t y l e to the present population. The find i n g that none of these 16 concurrent c o r r e l a t i o n s was s t a t i s t i c a l l y s i g n i f i c a n t suggests that depressive a t t r i b u t i o n a l s t y l e , as measured by the A t t r i b u t i o n a l Style Questionnaire (Peterson et a l . , Note 1), has l i t t l e , i f any re l a t i o n s h i p to>concurrent depression among well-educated women who are awaiting the b i r t h of t h e i r f i r s t c h i l d . The second general research issue i n the present study was to examine the p r e d i c t i v e u t i l i t y of a t t r i b u t i o n a l s t y l e i n i d e n t i f y i n g women who would be vulnerable to depression i n the f i r s t week postpartum. Ov e r a l l , the various a t t r i b u t i o n a l dimensions had l i t t l e to contribute i n pre d i c t i n g subsequent depression i n t h i s study. With the exception of the DACL, prenatal depression scores were the strongest predictors of depression 29 following c h i l d b i r t h . In the multiple regression analyses, s t a b i l i t y for negative outcomes was the only a t t r i b u t i o n a l dimension to make a s i g n i f i c a n t c ontribution to any of the three equations. Contrary to what would be predicted by the reformulated learned helplessness hypothesis, t h i s v a r i a b l e was weighted negatively. A t t r i b u t i o n a l g l o b a l i t y for p o s i t i v e outcomes made a s i g n i f i c a n t contribution to the discriminant function, and i t s negative weighting i s i n accordance with Abramson et a l . ' s (1978) formulation. I t s r o l e i n the equation was r e l a t i v e l y minor, however, given that each of the other two s i g n i f i c a n t v a r i a b l e s contributed approximately twice as much to the equation as did p o s i t i v e g l o b a l i t y . In f a c t , a discriminant function using only prenatal BDI and importance of negative outcomes as predictors would s t i l l be s t a t i s t i c a l l y s i g n i f i c a n t , IT (2,43) = 4. 61, p< .02, although the percentage of correct c l a s s i f i c a t i o n s would be reduced s l i g h t l y . The present findings therefore provide n e g l i g i b l e support for the p r e d i c t i v e u t i l i t y of depressive a t t r i b u t i o n a l s t y l e for t h i s group of women. Although t h i s study was not designed to test hypotheses based upon any other model of depression, the findings are consistent with Beck's formulation (Beck, 1967; Beck, Rush, Shaw, & Emery, 1979). According to Beck, a depressed i n d i v i d u a l tends to take a negative view of s e l f , the world, and the future, and generally to attend s e l e c t i v e l y to the negative. In the discriminant a n a l y s i s , and i n one of the multiple regression analyses, women's ratings of the importance of negative events emerged as a s i g n i f i c a n t predictor of depression. The BDI was another e f f e c t i v e predictor v a r i a b l e . I t may be useful for future studies of postpartum depression to pursue a more formal attempt to determine whether Beck's model of depression may be h e l p f u l i n i d e n t i f y i n g women who are vulnerable to depression following c h i l d b i r t h . The f i n d i n g that the discriminant 30 function was able to i d e n t i f y c o r r e c t l y seven of the eight depressed women i s promising, i n that i t lends support to the notion that postpartum depression may be predicted on the basis of prenatal depression and cognition. This study did not s p e c i f i c a l l y set out to e s t a b l i s h incidence estimates of postpartum depression; however, i t i s notable that 17% of the women i n t h i s sample reported depression of c l i n i c a l s e v e r i t y on at le a s t two of the three measures of depression administered on the t h i r d day postpartum. It may be useful to compare the present findings with those of other studies. Since incidence estimates based on the DACL and the McLean-Hakstian Scale are unavailable, i t seems most appropriate to compare the present BDI findings with those of other studies. In t h i s sample, 19.1% scored at or above 14 and 8.5% scored at or above 17 on the BDI. Both percentages are higher than those reported i n a study that used a cut-off score of 17 (Clarke & Williams, 1979), and lower than those reported i n studies that used 14 as the cut-off (Rees & Lutkins, 1971; Atkinson & R i c k e l , Note 2). The present sample bears closest resemblance to Atkinson and Rickel's (Note 2) sample, i n that both samples consisted of volunteers r e c r u i t e d from c h i l d b i r t h preparation classes. The present sample was somewhat higher with respect to age, education, and income, and exceeded the Canadian average on these v a r i a b l e s ( S t a t i s t i c s Canada, 1978, 1980). Caution should therefore be exercised i n generalizing the present incidence to the general population of primiparous women. Given that subjects were a l l unpaid volunteers, they may also have been more highly motivated than might be expected i n the general population. I t i s worthy of note that i n t h i s r e l a t i v e l y , homogeneous sample of middle cl a s s women, almost 20% experienced depression of c l i n i c a l s e v e r i t y . However, the 31 extent to which early postpartum depression correlates with l a t e r postpartum depression remains to be determined. What factors might account for the discrepancy between the present findings and those reported by Seligman et a l . (1979)? Several a l t e r n a t i v e explanations may be explored. Four general categories w i l l be considered, including factors related to a) the measurement of depression, b) systematic differences between the two samples, c) the general a p p l i c a b i l i t y of depressive a t t r i b u t i o n a l s t y l e as defined by the reformulated learned helplessness hypothesis, and d) experiment-wise error rates. One p o t e n t i a l source of d i s p a r i t y i s that the present measures of depression were not p r e c i s e l y the same as those used i n the o r i g i n a l study; however, they are highly comparable. Whereas Seligman et a l . (1979) employed the short form of the BDI and the depression scale of the MAACL (Multiple A f f e c t Adjective Check L i s t ) , the present study employed the f u l l BDI and the DACL B. The f u l l BDI correlates .96 with the short form (Beck & Beck, 1972), while the DACL B cor r e l a t e s .87 with the MAACL Depression Scale (Lubin, 1967). These figures are comparable with the estimates of i n t e r n a l consistency for these measures. Given the high c o r r e l a t i o n s between the present measures and those employed by Seligman et a l . , i t seems u n l i k e l y that t h i s d i f f e r e n c e i n the two studies could account for much of the discrepancy i n the find i n g s . Another explanatory factor to consider i s r e l a t e d , at le a s t i n part, to both measurement and sample issues. One of the systematic differences between the two samples i s that a l l subjects i n the present study are women, whereas t h i s was not the case i n the Seligman et a l . (1979) study. The authors do not report the number of males and females i n t h e i r sample of "145 undergraduate students i n an introductory psychology course at the 32 University of Pennsylvania" (p. 143), nor do they report separate findings for men and women. It has been suggested (e.g., Blumenthal, 1975) that men and women may d i f f e r i n the extent to which they are w i l l i n g to endorse items i n d i c a t i n g depression on s e l f - r e p o r t measures. If t h i s were indeed the case, then c o r r e l a t i o n s derived from mixed samples may be spuriously high. Suppose, for example, that a zero c o r r e l a t i o n e x i s t s between a t t r i b u t i o n a l s t y l e and BDI scores, but that normal women tend to score s i g n i f i c a n t l y higher on the BDI than do normal men. If a c o r r e l a t i o n c o e f f i c i e n t were calculated from the scores of both men and women, a t t r i b u t i o n a l s t y l e and depression would erroneously appear to be rel a t e d . A d i r e c t l y analogous problem would ex i s t i f there were s i g n i f i c a n t differences between men and women with respect to a t t r i b u t i o n a l s t y l e . Several factors would suggest, however, that t h i s p o t e n t i a l problem can be ruled out. Weissman and Klerman (1977) have suggested that there i s evid ence that men and women do not d i f f e r e n t i a l l y acknowledge depressive symptoms. Furthermore, Hammen and Padesky (1977) found no sex dif f e r e n c e i n BDI scores i n a large sample of college students. This f i n d i n g i s p a r t i c u l a r l y important in.that Seligman et a l . ' s c o r r e l a t i o n s of a t t r i b u t i o n and depression were highest for the BDI. In another sample of college students, Lubin (1965) found that men and women tended not to d i f f e r s i g n i f i c a n t l y with respect to t h e i r responses on the DACL. Peterson et a l . (Note 1) found that there were no s i g n i f i c a n t sex differences i n terms of responses to the A t t r i b u t i o n a l Style Questionnaire. Given these findings, i t seems u n l i k e l y that Seligman et a l . ' s c o r r e l a t i o n s were i l l u s o r y or that the differences i n gender i n the two samples could account for the disparate f i n d i n g s . Other systematic differences between the two samples may be more 33 c r i t i c a l . The present sample d i f f e r s markedly from the t y p i c a l sample of college undergraduates with respect to age, income, education, marital status, and occupation. Whether Seligman et al.'s findings generalize to a normal sample drawn from the general population remains an empirical question. Another more central difference between the two samples i s that the present sample of pregnant women represents a group for whom depression i s a c l i n i c a l l y relevant issue. It could perhaps be argued that postpartum depression has unique characteristics that d i f f e r e n t i a t e i t from other forms of non-psychotic depression, and that a t t r i b u t i o n a l patterns may therefore d i f f e r as wel l . In other words, the depressive a t t r i b u t i o n a l s t y l e that one might expect to find i n a general c l i n i c a l sample need not be expected i n a sample of pregnant women. However, the argument that postpartum depression i s d i s t i n c t from other forms of depression i s not i n keeping with the available evidence related to postpartum depression (cf. Fondeur et a l . , 1957; Paykel et a l . , 1980; P i t t , 1975; Reich & Winokur, 1970; Atkinson & Rickel, Note 2). Furthermore, the depressive a t t r i b u t i o n a l style has not yet been demonstrated i n a more general c l i n i c a l population. In a recent study conducted with a c l i n i c a l sample, Gong-Guy and Hammen (1980) found r e l a t i v e l y minimal evidence to support the notion of depressive a t t r i b u t i o n a l s t y l e , although their findings did "offer some support for hypotheses of cognitive mediation between s t r e s s f u l l i f e events and depression" (p. 666). The question remains as to whether Seligman et al.'s findings are relevant to any c l i n i c a l population. Evidence concerning the general a p p l i c a b i l i t y of depressive a t t r i b u t i o n a l style i s the thi r d issue to be considered. Although only a handful of researchers have addressed t h i s issue, the findings to date are 34 f a i r l y consistent i n that they tend to provide l i t t l e support for the hypothesized r e l a t i o n s h i p between depression and a t t r i b u t i o n a l s t y l e . The strongest support was found i n a study that correlated scores from Peterson et a l . ' s A t t r i b u t i o n a l Style Questionnaire (Note 1) with BDI scores i n a sample of college students (Blaney, Behar, & Head, 1980). Although most of the c o r r e l a t i o n s were s t a t i s t i c a l l y s i g n i f i c a n t , they were c o n s i s t e n t l y lower than those reported by Seligman et a l . (1979). Notably, the c o r r e l a t i o n between negative i n t e r n a l i t y and the BDI did not reach s t a t i s t i c a l . s i g n i f i c a n c e . Another study (Golin, Sweeney, & Shaeffer, 1981) analyzed the same measures i n a cross-lagged panel c o r r e l a t i o n a l a n a l ysis. Concurrent c o r r e l a t i o n s were not reported, but Golin et a l . noted that they were small, and suggested that the r e l a t i v e contribution of a t t r i b u t i o n s i n the development of depression i s yet to be established e m p i r i c a l l y . Two studies assessed depressive a t t r i b u t i o n a l s t y l e using actual l i f e events (Hammen & Cochran, 1981; Harvey, 1981). Harvey (1981) found that the i n t e r n a l i t y dimension was the only one to show the predicted r e l a t i o n s h i p with depression. He concluded that h i s findings "more c l e a r l y support a negative s e l f - a t t i t u d e model of depression" (p. 20) such as Beck (1967) has outlined. Hammen and Cochran (1981) found that depressed and non-depressed students did not d i f f e r i n t h e i r causal a t t r i b u t i o n s , although they did d i f f e r i n terms of other cognitions. In a more t r a d i t i o n a l helplessness study of experimenter-induced f a i l u r e , Pasahow (1980) found that subjects' ratings of a t t r i b u t i o n a l g l o b a l i t y did not e f f e c t the generalization of performance d e f i c i t s to another task. Taken together, these studies of student samples suggest that, although cognitive factors may play a r o l e i n depression, there i s l i t t l e support to date for the notion of depressive a t t r i b u t i o n a l s t y l e as defined by the reformulated 35 learned helplessness hypothesis. The f i n a l issue to be considered i s the problem of cluster-wise error r a t e s . As Larzelere and Mulaik (1977) have pointed out, When more than one c o r r e l a t i o n c o e f f i c i e n t i s tested for s i g n i f i c a n c e i n a study, the p r o b a b i l i t y of making at least one Type I error r i s e s r a p i d l y as the number of tests increases, and the p r o b a b i l i t y of making a Type I error a f t e r a Type I error on a previous test i s usually greater than the nominal s i g n i f i c a n c e l e v e l used i n each test (p. 557). Methods such as the Bonferroni procedure have been devised to take t h i s problem into account; however, many studies do not control for t h i s source of error. The Seligman et a l . (1979) a r t i c l e represents one such study. Seligman et a l . reported the c o r r e l a t i o n s of eight a t t r i b u t i o n a l subscales with two measures of depression, and performed 16 i n d i v i d u a l s i g n i f i c a n c e tests on these c o r r e l a t i o n s . Using a cluster-wise s i g n i f i c a n c e l e v e l of .05, the Bonferroni procedure would set the s i g n i f i c a n c e l e v e l for each i n d i v i d u a l test at .05/16= .0031. Only the c o r r e l a t i o n s between negative a t t r i b u t i o n s and the BDI had j> values f a l l i n g below t h i s l e v e l . Thus, with t h i s exception, the n u l l hypothesis cannot be rejected when cluster-wise error rates are taken into account. It would appear, then, that even Seligman et a l . ' s (1979) evidence regarding the r e l a t i o n s h i p between depressive a t t r i b u t i o n a l s t y l e and concurrent depression i s somewhat weak. To conclude, the present study found that Seligman et a l . ' s (1979) findings could not be r e p l i c a t e d i n a prenatal sample of primiparous women, nor was prenatal a t t r i b u t i o n a l s t y l e p r e d i c t i v e of depression following c h i l d b i r t h . The discrepant findings of the present study as compared with the Seligman et a l . study cannot be adequately accounted for by factors r e l a t e d to measurement issues or to gender differences between the two samples. It would seem, then, that the notion of depressive a t t r i b u t i o n a l s t y l e i s not generalizable to the population from which the present sample 36 was drawn. Whether depressive a t t r i b u t i o n a l s t y l e i s indeed applicable to any population remains an open question. The evidence to date i s weak. While i t would be premature to conclude that the reformulated learned helplessness hypothesis i s i n v a l i d i n i t s present form, one might speculate that other cognitive factors may play a more prominent r o l e i n the development of depression. The present findings were more i n keeping with Beck's formulation (1967) than with Abramson et a l . ' s (1978). This was also the case i n Harvey's (1981) study. Hammen and Cochran (1981) have suggested that an examination of the perceived consequences of events may be a productive area for research of depressive cognition. As Gong-Guy and Hammen (1980) have suggested, i t would appear that several cognitive factors may contribute to depression, and that an adequate model of depression i s l i k e l y to elude us for some time to come. 37 Reference Notes 1. Peterson, D., Semmel, A., von Baeyer, C , Abramson, L. Y., Metalsky, G. I., & Seligman, M. E. P. The a t t r i b u t i o n a l s t y l e questionnaire. Unpublished manuscript, U n i v e r s i t y of Pennsylvania, 1980. 2. Atkinson, A. K., R i c k e l , A. U. Postpartum adjustment i n primiparous  parents. Paper presented at the Society for Research i n Child Development B r i t i s h Annual Meeting, Boston, A p r i l , 1981. 3. Bradley, C. F. The e f f e c t s of h o s p i t a l experience on postpartum  fe e l i n g s and att i t u d e s of women. Unpublished doctoral d i s s e r t a t i o n , U n i v e r s i t y of B r i t i s h Columbia, 1976. 4. McLean, P., & Hakstian, A. R. Manuscript i n preparation, U n i v e r s i t y of B r i t i s h Columbia, 1981. 38 References Abramson, L. Y., Seligman, M. E. P., & Teasdale, J. D. Learned helplessness i n humans: C r i t i q u e and reformulation. Journal of Abnormal Psychology, 1978, 87, 49-74. Beck, A. T. Depression: C l i n i c a l , experimental, and t h e o r e t i c a l aspects. New York: Hoeber, 1967. Beck, A. T., & Beck, R. W. Screening depressed patients i n family p r a c t i c e : A rapid technic. Postgraduate Medicine, 1972, 52^ , 81-85. Beck, A. T., Rush, A. J . , Shaw, B. F., & Emery, G. Cognitive therapy of  depression. New York: Guildford Press, 1979. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J . , & Erbaugh, J. Inventory for measuring depression. Archives of General Psychiatry, 1961, 561-571. Blaney, P. H., Behar, V., & Head, R. Two measures of depressive cognitions: Their a s s o c i a t i o n with depression and with each other. Journal of  Abnormal Psychology, 1980, 89, 678-682. Blumberg, N. L. E f f e c t s of neonatal r i s k , maternal a t t i t u d e , and cognitive s t y l e on early postpartum adjustment. Journal of Abnormal Psychology, 1980, 89_, 139-150. Blumenthal, M. D. Measuring depressive symptomatology i n a general population. Archives of General Psychiatry, 1975, 32_, 971-978. Braverman, J . , & Roux, J. F. Screening for the patient at r i s k for postpartum depression. Obstetrics and Gynecology, 1978, j52_, 731-736. Charles, A. G., Norr, K. L., Block, D. R., Meyering, S., & Meyers, E. Obstetric and psychological e f f e c t s of psychoprophylactic preparation for c h i l d b i r t h . American Journal of Obstetrics and Gynecology, 1978, 131, 44-52. Clarke, M., & Williams, A. J . Depression i n women af t e r p e r i n a t a l death. Lancet, 1979, No. 8122, 916-917. Co s t e l l o , C. G. A c r i t i c a l review of Seligman's laboratory experiments on learned helplessness and depression i n humans. Journal of Abnormal  Psychology, 1978, 87_, 21-31. Dalton, K. Prospective study into puerperal depression. B r i t i s h Journal  of Psychiatry, 1971, U8, 689-692. Depue, R. A., & Monroe, S. M. Learned helplessness i n the perspective of the depressive disorders: Conceptual and d e f i n i t i o n a l issues. Journal  of Abnormal Psychology, 1978, 87, 3-20. 39 Felton, G. S., & Segelman, F. B. Lamaze c h i l d b i r t h t r a i n i n g and changes i n b e l i e f about personal c o n t r o l . B i r t h and the Family Journal, 1978, 5_, 141 -150 . Fondeur, M. A., Eixsen, B. C., T r i e b e l , W. A., & White, M. A. Postpartum mental i l l n e s s , a con t r o l l e d study. Archives of Neurological Psychiatry, 1957, 77, 503 -512 . Gelder, M. Hormones and post-partum depression. In M. Sandler (Ed.), Mental i l l n e s s i n pregnancy and the puerperium. Oxford: Oxford Uni v e r s i t y Press, 1978. Golin, S., Sweeney, P. D., & Shaeffer, D. E. The c a u s a l i t y of causal a t t r i b u t i o n s i n depression: A cross-lagged panel c o r r e l a t i o n a l a n a lysis. Journal of Abnormal Psychology, 1981, 14 -22 . Gong-Guy, E., & Hammen, C. Causal perceptions of s t r e s s f u l events i n depressed and nondepressed outpatients. Journal of Abnormal Psychology, 1980, 8 9 , 662 -669 . Grundy, P. F., & Roberts, C. J . Observations on the epidemiology of post partum mental i l l n e s s . Psychological Medicine, 1975, J5, 286 -290 . Hammen, C. L., & Cochran, S. D. Cognitive c o r r e l a t e s of l i f e stress and depression i n college students. Journal of Abnormal Psychology, 1981, 90, 2 3 - 27 . Hammen, D. L., & Padesky, C. A. Sex differences i n the expression of depressive responses on:the Beck Depression Inventory. Journal of Abnormal Psychology, 1977, 86, 609 -614 . Harvey, D. M. Depression and a t t r i b u t i o n a l s t y l e : Interpretations of important personal events. Journal of Abnormal Psychology, 1981, 90. 134-142. Hayworth, J . , L i t t l e , B. C , Bonham Carter, S., Raptopoulos, P., P r i e s t , R. G., & Sandler, M. A p r e d i c t i v e study of post-partum depression: Some predisposing c h a r a c t e r i s t i c s . B r i t i s h Journal of Medical  Psychology, 1980, 53 , 161 -167 . Herzog, A., & Detre, T. Psychotic reactions associated with c h i l d b i r t h . Diseases of the Nervous System, 1976, 37. > 229 - 235 . Hiroto, D. S. Locus of control and learned helplessness. Journal of Experimental Psychology, 1974, 102, 187 -193 . Larzelere, R. E., & Mulalk, S. A. Single-sample t e s t s for many c o r r e l a t i o n s . Psychological B u l l e t i n , 1977, 84, 557 -569 . Lubin, B. Adjective c h e c k l i s t s for the measurement of depression. Archives  of General Psychiatry, 1965, JJ2, 5 7 - 62 . Lubin, B. Manual for the Depression Adjeetive Check L i s t s . San Diego, Ca.: Educational and I n d u s t r i a l Testing Service, 1967. 40 Lubin, B., & Himelstein, P. R e l i a b i l i t y of the Depression Adjective Check L i s t s . Perceptual and Motor S k i l l s , 1976, 43, 1037-1038. Martin, M. E. A maternity h o s p i t a l study of p s y c h i a t r i c i l l n e s s associated with c h i l d b i r t h . I r i s h Journal of Medical Science, 1977, 146, 239-244. Meares, R. , Grimwade, J . , & Wood, C. A possible r e l a t i o n s h i p between anxiety i n pregnancy and puerperal depression. Journal of  Psychosomatic Research, 1976, 20, 605-610. M i l l e r , W. R., R o s e l l i n i , R. A., & Seligman, M. E. P. Learned helplessness and depression. In J . B. Maser and M. E. P. Seligman (Eds.), Psychopathology: Experimental models. San Francisco: Freeman, 1977. M i l l e r , W. R., & Seligman, M. E. P. Depression and learned helplessness i n man. Journal of Abnormal Psychology, 1975, 84_, 228-238. Pasahow, R. J . The r e l a t i o n between an a t t r i b u t i o n a l dimension and learned helplessness. Journal of Abnormal Psychology, 1980, 89_, 358-367. Paschall, N., & Newton, N. Personality factors and postpartum adjustment. Primary Care, 1976, 3, 741-750. Paykel, E. S., Emms, E.' M., Fletcher, J . , & Rassaby, E. S. L i f e events and s o c i a l support i n puerperal depression. B r i t i s h Journal of Psychiatry, 1980, 136, 339-346. P i t t , B. " A t y p i c a l " depression.following c h i l d b i r t h . B r i t i s h Journal of  Psychiatry, 1968, 114, 1325-1335. Pugh, T. F., Jerath, B. K., Schmidt, W. M., & Reed, R. B. Rates of mental disease related to child-bearing. New England Journal of Medicine, 1963, 268, 1224-1228. Rees, W., & Lutkins, S. Parental depression before and a f t e r c h i l d b i r t h . Journal of the Royal College of General P r a c t i t i o n e r s , 1971, _21, 20-31. Reich, T., & Winokur, G. Postpartum psychoses i n patients with manic depressive disease. Journal of Nervous and Mental Disease, 1970, 151, 60-68. Rehm, L. P. Assessment of depression. In M. Hersen & A. S. Bellack (Eds.), Behavioral assessment: A p r a c t i c a l handbook. Oxford: Pergamon Press, 1976. Rizley, R. Depression and d i s t o r t i o n i n the a t t r i b u t i o n of c a u s a l i t y . Journal of Abnormal Psychology, 1978, 87_, 32-48. Seiden, A. M. The maternal sense of mastery i n primary care o b s t e t r i c s . Primary Care, 1976, 3^, 717-726. Seligman, M. E. P. Helplessness: On depression, development and death. San Francisco: Freeman, 1975. 41 Seligman, M. E. P., Abramson, L. Y., Semmel, A., & von Baeyer, C. Depressive a t t r i b u t i o n a l s t y l e . Journal of Abnormal Psychology, 1979, 88, 242-247. Sheehan, I. Assessing postpartum adjustment: A p i l o t study. JOGN Nursing, 1981, H), 19-22. S t a t i s t i c s Canada. Canada Year Book, 1978-79. Ottawa: Supply and Services Canada, 1978. i Stat i s t i c s Canada. V i t a l S t a t i s t i c s : Volume 1, Birth s and Deaths, 1978. Ottawa: Supply and Services Canada, 1980. Steiner, M. Psychobiology of mental disorders associated with childbearing: An overview. Acta P s y c h i a t r i c a Scandinavica, 1979, ^0, 449-464. Uddenberg, N., & Englesson, I. Prognosis of postpartum mental disturbance: A prospective study of primiparous women and t h e i r 4%-year-old c h i l d r e n . Acta P s y c h i a t r i c a Scandinavica, 1978, 5J3, 201-212. Uddenberg, N., & Nilsson, L. The l o n g i t u d i n a l course of para-natal emotional disturbance. Acta P s y c h i a t r i c a Scandinavica, 1975, 52, 160-169. Vandenbergh, R. L. Postpartum depression. C l i n i c a l O bststrics and  Gynecology, 1980, 23, 1105-1111. Weissman, M. M., & Klerman, G. L. Sex differences and the epidemiology of depression. Archives of General Psychiatry, 1977, 3^4, 98-111. Williams, J. G., Barlow, D. H., & Agras, W. S. Behavioral measurement of severe depression. Archives of General Psychiatry, 1972, 27_, 330-333. Yalom, I. D., Lunde, D. T., Moos, R. H., & Hamburg, D. A. Postpartum blues syndrome: A de s c r i p t i o n and rela t e d v a r i a b l e s . Archives of General  Psychiatry, 1968, 18, 16-27. Zajicek, E., & Wolkind, S. Emotional d i f f i c u l t i e s i n married women during and a f t e r the f i r s t pregnancy. B r i t i s h Journal of Medical Psychology, 1978, 51_, 379-385. Appendix A A t t r i b u t i o n a l Style Questionnaire Code H Date DIRECTIONS Please t r y to v i v i d l y imagine yourself i n the sit u a t i o n s that follow. I f such a s i t u a t i o n happened to you, what would you f e e l would have caused i t ? While events may have many causes, we want you to pick only one — the major cause i f t h i s event happened to you. Please write t h i s cause i n the blank provided a f t e r each event. Next we want you to answer some questions about the cause and a f i n a l question about the s i t u a t i o n . To summarize, we want you to: 1) Read each s i t u a t i o n and v i v i d l y imagine i t happening to you. 2) Decide what you f e e l would be the major cause of the s i t u a t i o n i f i t happened to you. 3) Write one cause i n the blank provided. 4) Answer three questions about the cause. 5) Answer one question about the s i t u a t i o n . 6) Go on to the next s i t u a t i o n . 4 4 YOU MEET A FRIEND WHO COMPLIMENTS YOU ON YOUR APPEARANCE. 1) Write down the one major cause ^ 2) Is the cause of your friend's compliment due to something about you or something about the other person circumstances? ( C i r c l e one number) T o t a l l y due to the other person or T o t a l l y due circumstances 1 2 3 4 5 6 7 to me 3) In the future when you are with your friends, w i l l t h i s cause again be present? ( C i r c l e one number) W i l l never again be W i l l always present 1 2 3 4 5 6 7 be present 4) Is the cause something that j u s t a f f e c t s Interacting with friends or does i t also influence other areas of your l i f e ? ( C i r c l e one number) Influences j u s t t h i s Influences p a r t i c u l a r a l l s i t u a t i o n s s i t u a t i o n 1 2 3 4 5 6 7 i n my l i f e 5) How important would t h i s s i t u a t i o n be i f i t happened to you? ( C i r c l e one number) Not at a l l Extremely important 1 2 3 4 5 6 7 Important YOG -:im. '122:1 locux-w POX A aov. u-isaxxssFuLLY «o.:*sa-s T I ~ . 6) Write down one major cause 7) Is the cause of your unsuccessful job search due to something about you or some-thing about other people or circumstances? ( C i r c l e one number) T o t a l l y due to other people T o t a l l y due or circumstances 1 2 3 4 5 6 7 to me 8) In the future when looking for a job, w i l l t h i s cause again be present? ( C i r c l e one number) W i l l never again be W i l l always present 1 2 3 4 5 6 7 be present 9) Is the cause something that j u s t influences looking for a job or does i t also influence other areas of your l i f e ? ( C i r c l e one number) Influences j u s t t h i s Influences p a r t i c u l a r a l l situations s i t u a t i o n 1 2 3 4 5 6 7 In my l i f e 10) How important would t h i s s i t u a t i o n be i f i t happened to you? ( C i r c l e one number) Not at a l l Extremely Important 1 2 3 4 5 6 7 important 2 45 YOU BECOME VERY RICH. 11) Write down the one major cause 12) Is the cause of your becoming r i c h due to something about you or something about other people or circumstances? T o t a l l y due to other people T o t a l l y due or circumstances 1 2 3 4 5 6 7 to me 13) In your f i n a n c i a l future, w i l l t h i s cause again be present? W i l l never again be W i l l always present 1 2 3 4 5 6 7 be present 14) Is the cause something that j u s t a f f e c t s obtaining money or does i t also influence other areas of your l i f e ? Influences j u s t Influences a l l t h i s p a r t i c u l a r s i t u a t i o n s i n s i t u a t i o n 1 2 3 4 5 6 7 my l i f e 15) How important would t h i s s i t u a t i o n be i f i t happened to you? Not at a l l Extremely Important 1 2 3 4 5 6 7 important A FRIEND COMES TO YOU WITH A PROBLEM AND YOU DON'T TRY TO HELP THEM. 16) Write down the one major cause 17) Is the cause of your not helping your f r i e n d due to something about you or something about other people or circumstances? ( C i r c l e one number) T o t a l l y due to other people or T o t a l l y due circumstances 1 2 3 4 5 6 7 to me 18) In the future when a f r i e n d comes to you with a problem, w i l l t h i s cause again be present? ( C i r c l e one number) W i l l never again W i l l always be present 1 2 3 4 5 6 7 be present 19) Is the cause something that j u s t a f f e c t s what happens when a f r i e n d comes to you with a problem or does i t also Influence other areas of your l i f e ? ( C i r c l e one number) Influences j u s t Influences a l l t h i s p a r t i c u l a r s i t u a t i o n s l n s i t u a t i o n 1 2 3 4 5 6 7 my l i f e 20) How important would t h i s s i t u a t i o n be i f i t happened to you? ( C i r c l e one number) Not at a l l Extremely important 1 2 3 4 5 6 7 important 3 46 YOU GIVE AN IMPORTANT TALK IN FRONT OF A GROUP AND THE AUDIENCE REACTS NEGATIVELY. 21) Write down the one major cause 22) Is the cause of the audience reacting negatively due to something about you or something about other people or circumstances? ( C i r c l e one number) T o t a l l y due to. other people or T o t a l l y due circumstances 1 2 3 4 5 6 7 to me 23) In the future when giving t a l k s , w i l l t h i s cause a t a i n be present? ( C i r c l e one number) W i l l never again be W i l l always present 1 2 3 4 5 6 7 be present 24) Is t h i s cause something that j u s t influences giving t a l k s or does i t also Influence other areas of your l i f e ? ( C i r c l e one number) Influences j u s t Influences a l l t h i s p a r t i c u l a r s i t u a t i o n s l n s i t u a t i o n 1 2 3 4 5 6 7 my l i f e 25) How Important would t h i s s i t u a t i o n be i f i t happened to you? ( C i r c l e one number) Not at a l l Extremely important 1 2 3 4 5 6 7 Important YOU DO A PROJECT WHICH IS HIGHLY PRAISED. 26) Write down the one major cause 27) Is the cause of being praised due to something about you or something about other people or circumstances? T o t a l l y due to other people or T o t a l l y due circumstances 1 2 3 4 5 6 7 to me 28) In the future when doing a project, w i l l t h i s cause again be present? W i l l never again be W i l l always present 1 2 3 4 5 6 7 . be present 29) Is t h i s cause something that j u s t a f f e c t s doing projects or does I t a l s o influence other areas of your l i f e ? Influences j u s t Influences a l l t h i s p a r t i c u l a r s i t u a t i o n s i n s i t u a t i o n 1 2 3 4 5 6 7 my l i f e 30) How Important would t h i s s i t u a t i o n be i f It happened to you? Not at a l l Extremely Important 1 2 3 4 5 6 7 Important 4 47 YOU MEET A FRIEND WHO ACTS HOSTILELY TOWARD YOU. 31) Write down the one major cause 32) Is the cause of your f r i e n d acting h o s t i l e due to something about you or some-thing about other people or circumstances? ( C i r c l e one number) T o t a l l y due to other people or T o t a l l y due circumstances 1 2 3 4 5 6 7 to me 33) In the future when int e r a c t i n g with f r i e n d s , w i l l t h i s cause again be present? ( C i r c l e one numbar) W i l l never again be W i l l always present 1 2 3 4 5 6 7 be present 34) Is the cause something that j u s t influences i n t e r a c t i n g with friends or does i t also influence other areas of your l i f e ? ( C i r c l e one number) Influences j u s t Influences a l l t h i s p a r t i c u l a r s i t u a t i o n s i n s i t u a t i o n 1 2 3 4 5 6 7 my l i f e 35) How important would t h i s s i t u a t i o n be i f i t happened to you? ( C i r c l e one number) Not at a l l Extremely important 1 2 3 4 5 6 7 Important YOU GET ALL TiE JDRK DQiiE TttiT OTHERS EXPECT OF YOU*: - — - -36) Write down the one major cause 37) Is the cause of your not getting the work done due to something about you or something about other people or circumstances? T o t a l l y due to other people or T o t a l l y due circumstances 1 2 3 4 5 6 7 to me 38) In the future when doing the work that others expect, w i l l t h i s cause be present? W i l l never again be W i l l always present 1 2 3 4 5 6 7 be present 39) Is the cause something that j u s t a f f e c t s doing work that others expect of you or does i t also influence other areas of your l i f e ? Influences j u s t Influences a l l t h i s p a r t i c u l a r s i t u a t i o n s i n s i t u a t i o n 1 2 3 4 5 6 7 my l i f e 40) How important would t h i s s i t u a t i o n be i f i t happened to you? Not at a l l important 1 2 3 4 5 6 7 Extremely important 5 48 YOUR SPOUSE (PARTNER) HAS BEEN TREATING YOU MORE LOVINGLY. Al) Write down the one major cause 42) Is the cause of your spouse (partner) t r e a t i n g you more l o v i n g l y due to some-thing about you or something about other people or circumstances? ( C i r c l e one number) T o t a l l y due to other people or T o t a l l y due circumstances 1 2 3 4 5 6 7 to me 43) In future interactions with your spouse (partner), w i l l t h i s cause again be present? ( C i r c l e ^ ond number) W i l l never again be W i l l always present 1 2 3 4 5 6 7 be present 44) Is t h i s cause something that j u s t a f f e c t s how your spouse (partner) treats you or does i t also Influence other areas of your l i f e ? ( C i r c l e one number) Influences j u s t Influences a l l t h i s p a r t i c u l a r Situations i n s i t u a t i o n 1 2 3 4 5 6 7 my l i f e 45) How Important would t h i s s i t u a t i o n be i f i t happened to you? ( c i r c l e one number) Not at a l l Extremely Important 1 2 3 4 5 6 7 Important . TOD APPLY FOR A POSITIOH THAT YOU T£OT VHRY BADLY feq IMPORTANT JOB, GRADUATE SCHOOL ADMISSION, etc.) AND YOU GET IT. 46) Write down one major cause 47) Is the cause of your getting the p o s i t i o n due to something about you or some-thing about other people or circumstances? T o t a l l y due to other people or T o t a l l y due circumstances 1 2 3 4 5 6 7 to me 43) In the future when applying for a p o s i t i o n , w i l l t h i s cause again be present? W i l l never again be W i l l always present 1 2 3 4 5 6 7 be present 49) Is the cause something that j u s t influences applying f o r a p o s i t i o n or does i t also influence other areas of your l i f e ? Influences j u s t Influences a l l t h i s p a r t i c u l a r s i t u a t i o n s In s i t u a t i o n 1 2 3 4 5 6 7 my l i f e 50) How important would t h i s s i t u a t i o n be i f i t happened to you? Not at a l l Extremely important 1 2 3 4 5 6 7 Important 6 TOO 00 OUT TOR T a E T W E T n C A C r r ODES BAOLY. 51) Write down one major cause. 52) Is the cause of the dinner going badly due to something about you or something about other people or circumstances? ( C i r c l e one number.) T o t a l l y due to T o t a l l y due other people or to me circumstances 1 2 3 4 5 6 7 53) In the future when goins out fo r dinner w i l l t h i s cause again be present? W i l l never W i l l always again be present 1 2 3 4 5 6 7 be present 54) Is the cause something that just influences going out fo r dinner or does i t also influence other areas of your l l f a ? Influences j u s t Influences a l l t h i s p a r t i c u l a r s i t u a t i o n s i n s i t u a t i o n 1 2 3 4 5 6 7 m y l i f e 55) How Important would t h i s s i t u a t i o n be i f i t happened to you? Not at a l l Extremely important 1 2 3 4 5 6 7 important YOU GET A RAISE IN YOUR SALARY. 56) Write down the one major cause. 57) Is the cause of your getting a r a i s e due to something about you or something about other people or circumstances? T o t a l l y due to T o t a l l y due other people or to me circumstances 1 2 3 4 5 6 7 53) In the future on your job, w i l l t h i s cause again be present? W i l l never again W i l l always be present 1 2 3 4 5 6 7 be present 59) Is t h i s cause something that just a f f e c t s getting a r a i s e or does i t also influence other areas of your l i f e ? Influences just t h i s Influences a l l p a r t i c u l a r s i t u a t i o n 1 2 3 4 5 6 7 s i t u a t i o n s i n my l i f e 60) How important would t h i s s i t u a t i o n be i f i t happened to you? Not at a l l Extremely important 1 2 3 4 5 6 7 important Appendix B Beck Depression Inventory 5 1 BECK mmnxm Code # . tete _  Ca t h l o questionnaire e r a groups of etatotants. Pleane read each group of statements c a r e f u l l y . Then pick out the one otateEent In each group which best describes the way you have been f e e l i n g the fAST WEEK. IHCLOPISS TPPAT! C i r c l e - t h e number beside the statement you picked. If several statements In the group sees to apply equally w e l l , c i r c l e each one. Be sure to read a l l the statements In each group before asking your choice. 1 0 1 do not f e e l sad. 1 I f e e l sad. 2 I am sad a l l the time and I can't snap out of i t . 3 I am so sad or unhappy that I can't -tand I t . 2 0 I am not p a r t i c u l a r l y discouraged about the future. 1 I f e e l discouraged about the future. 2 I f e e l I have nothing to look forward to. 3 I f e e l that the future i s hopeless and that things cannot lsprove. 3 0 I do s o t f e e l l i k e a f a i l u r e . 1 I f e e l I have f a i l e d more than the average pcroon. 2 As I look back on my l i f e , a l l I can see Is a l o t of f a i l u r e s . 3 I f e e l I am a complete f a i l u r e as s person. 4 0 1 get as much s a t i s f a c t i o n out of thinga a* I used t o . 1 I don't enjoy things tho way I.used Co. 2 I don't get r e a l s a t i s f a c t i o n out of anything any mere. 3 I am d i s s a t i s f i e d o r bored with everything. 5. 0 I don't f e e l p a r t i c u l a r l y g u i l t y . 1 X f e e l g u i l t y a good part of the time. 2 I f e e l quite g u i l t y aost of the tiase. 3 I f e e l g u i l t y a l l o f the t i n e . 6 0 1 don't f e e l I am being punished. 1 I f e e l I may be punished. 2 I expect to be punished. 3 I f e e l I am being punished. 7 0 1 don't f e e l disappointed l a myself. 1 I am disappointed i n myself. 2 I am disgusted with myself. 3 I hate myself. 8 0 1 don't f e e l I am any worse than anybody e l s e . a I am c r i t i c a l of .myself for my weaknesses or mistakes. 2 I blame myself a l l the time for my f a u l t s . 3 I blame myself ' l o r jeverythlng bad that happens. 9 0 1 don't have any thoughts of k l l l i u g my a e l f . 1 I have thoughts of k i l l i n g myself, but I would not carry than out. 2 I would l i k e to k i l l myself« 3 I would k i l l myself I f I had the chance. 10 0 I don't c r y any more than usual. 1 I cry more now than I used to. 2 I cry a l l the time now. 3 I used, to be able to cry, but now 1 can't cry even though 1 want t o . Copyright e. 1972 by Aaron T. Be«k, M.D. 52 11 -0 1 aa no BozaJLcziXated *>bw th^jn I ever em. 1 I get annoyed g * . i r r i t a t e d pore a/taily than I used to. 2 I f e e l i r r i t a t e d a i l , t h a t i p a now.. 3 1 tioo't get i r r i g a t e d at a U hy the things chat used to. I r r i t a t e ras. 12 0 I have not lo>t interest,. In, other, people, . 1 I am l e s s interested i n other people-^hant used -to be. 2 I have l o s t most of my i n t e r e s t l n other people. 3 I have l o s t a l l of my i n t e r e s t l n other people. 13 0 I make decisions about as well as I ever could. 1 I put o f f making decisions more thun I used to. 2 I have greater d i f f i c u l t y i n making decisions than before 3 I can't make decisions at a l l any more. 14 0 I don't f e e l I look c_y worse than I used to. 1 I am worried that I am looking old or unattractive. 2 I f e e l that there are permanent changes l n my appearance that make me look unattractive. 3 I believe that I look *igly. 15 0 I can work about as w e l l as before. 1 I t takes an extra e f f o r t to gat 'started "a* doing something. 2 I have to push myself very hard to flo anything. 3 I can't do any work ar a l l . ' 16 0 I can sleep as well as usual. 1 I don't sleep as well as I used t o . 2 I wake up 1-2 hours e a r l i e r than usual and f i n d I t hard to get back to sleep. 3 I wake up several hours e a r l i e r than I need to and cannot get bach to a l e c s . 17 0 I don't get more t i r e d than usual. 1 I get t i r e d more e a s i l y than I used to. 2 I get t i r e d from doing almost anything. 3 I am too t i r e d to do anything. 18 0 My appetite i s no worse than usual. 1 My appetite Is not as good as i t used to Ve. 2 My appetite Is much worse now. 3 I have no appetite at a l l any more. 19 0 I am no more worried about my health than .usual. . . . 1 I am worried about physi«a.l proDiems such eg achaa and psins: or upset stoma eh; or constipation. ' _ 2 I am very worried about physical problems and lt*q hard to tislsk ot Bneh e l e e l 3 I am so worried about my physical problems that I cannot think about' anything e l s e . 20 0 I have not noticed any recent change l n my Interest in aex. 1 I am l e s s Interested l n sex than I used to be. 2 I am much l e s s Interested i n sex now. \ 3 I have l o s t i n t e r e s t l n sex completely. Reproduction without author'8 express wr i t t e n eonaent i s forbiddeiu A d d i t i o n a l copies and/or permission to use t h l a s c a l e may be obtained f r o n : CENTER FOR COGNITIVE THERAPY, Room 6Q2, 133 South 36th Street, P h i l a d e l p h i a , Pa. X9104 Appendix C Depression Adjective Check L i s t s 54 PHP32a-2/77 Name_ Date_ CHECK LIST DACL FORM B By Bernard Lubin Age. .Sex. Highest grade completed in school. DIRECTIONS: Below you will find words which describe different kinds of moods and feelings. Check the words which describe How You Feel Now - - Today. Some of the words may sound alike, but we want you to check a l l the words that describe  your feelings. Work rapidly and check all of the words which describe how you feel today. 1. • Downhearted 17. • Clean ° 2. • Lively 18. • Dispirited 3. • Unfeeling 19. • Moody 4. • Alone 20. • Pleased 5. • Unhappy •21. • Dead 6. • Alive 22. • Sorrowful 7. • Terrible 23. • Bleak 8. • Poor 24. • Light 9. • Forlorn 25. • Morbid 10. • Alert 26. • Heavy - hearted 11. • Exhausted 27. • Easy - going 12. • Heartsick 28. • Gray 13. • Bright 29. • Melancholy 14. • Glum 30. • Hopeful 15. • Desolate 31. • Mashed 16. • Composed 32. • Unlucky f OAC 0O2 flMIIMIII ' TM7 h. M t m • i w i - i n M a n a i i i i m c i i n i i - i i w — — i - t . m m i iMmm reproduced with peraissiaa CITY OF VANCOUVER HEALTH DEPARTMENT 55 PHP32d-2/77 CHECK LIST DACL FORM E By Bernard Lubin Name Age Sex Date Highest grade completed In school DIRECTIONS: Below you will find words which describe different kinds of moods and feelings. Check the words which describe How You Feel Now — Today. Some of the words may sound alike, but we want you to check all the words that describe  your feelings. Work rapidly and check a l l of the words which describe how you feel today. 1. • Unhappy 18. • Well 2.D Active 19. • Apathetic 3. • Blue 20. • Chained 4- • Downcast 21. • Strong 5. • Dispirited 22." • Dejected 6. • Composed 23. • Awful 7. • Distressed 24. • Glum 8. • Cheerless 25. • Great 9. • Lonely 26. • Finished 10. • Free 27. • Hopeless 11. • Lost 28. • Lucky 12. • Broken 29. • Tortured 13. • Good 30. • Listless 14. • Burdened 31. • Safe 15. • Forlorn 32. • Wilted 16. • Vigorous 33. • Criticized 17. • Peaceful 34. • F i t DAC 006 COrvittMf * >«tf I* BPUCAtlOHM * MMTtt t t TMTMQ tOVKt. U N M O O . CAUPOCMA *IMT WOCUCTIOM 0# T M MttM IT AMY M U M OTKTLT t CITY BP VANCOUVER HEALTH DEPARTMENT reproduced with permission "7* Appendix D McLean - Hakstian Scale 57 Code No: 1. How relaxed have you been i n the l a s t 2 days compared to how you normally are? (please c i r c l e appropriate no.) 10 9 8 7 6 5 4 3 2 1 Extremely Calm & relaxed tense p h y s i c a l l y 2. Bow s a t i s f i e d are you with your a b i l i t y to perform household duties? 10 9 8 7 6 5 4 3 2 1 Very d i s s a t i s f i e d Very s a t i s f i e d 3. To what extent have you had d i f f i c u l t y s t a r t i n g and following through an ordinary Job or task to completion during the l a s t week compared to when you f e e l things have been going well? 10 9 8 7 6 5 4 3 2 1 Putting things o f f . Start and f i n i s h S t a r t i n g and not jobs as w e l l as f i n i s h i n g f o r a long most other people time, i f at a l l 4. How many times during the l a s t 2 days have you been preoccupied by thoughts of hopelessness, helplessness, pessimism. Intense worry, unhappiness, etc. Please t i c k one of the boxes below: 1. not at a l l 2. r a r e l y 3. frequently 4. most of the time — 5. a l l of the time 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0094990/manifest

Comment

Related Items