[Depressive disorder following personnel change--its clinical features, situational factors antecedent to recovery and treatment].
It is well known that occupational personnel change is one of the life events which frequently precipitates the onset of depressive disorder. This study examines the demographic, social and clinical features of unipolar depressives whose onsets were precipitated by recent occupational personnel changes. These index patients are compared with those whose onsets were precipitated by other life events. Information was obtained retrospectively by the patients' medical records, and diagnoses were made according to the Research Diagnostic Criteria. Of 130 patients with unipolar depression (58 males and 72 females), 18 had onsets precipitated by occupational personnel changes. Of these 18 cases, 17 were male and only one was female. Therefore, personnel change can be said to be a major precipitating factor for Japanese men. This clear sex difference is considered to be due to the difference between men's and women's attitudes toward their jobs. This distinction is not found in European countries. The comparisons between the male index patients and the others of the same sex revealed that the former had the following demographic and social features; a narrower age distribution averaging in the early 40s (p < .05), more education (p < .05) and higher rate of marriage (p < .02). As for the subtype of depressive illness, the index patients were all categorized as endogenous unipolar depression in contrast to neurotic depression. These findings suggest that unipolar depressives whose onsets were precipitated by occupational personnel changes have uniform demographic and social features and subtype of depressive illness. Therefore, they can be delineated as a clinical subgroup. The index patients had a higher rate of attempted suicide (29%) than the other patients (p < .05). One explanation for the higher rate is that Japanese employees have a strong sense of belonging to their companies. The examination of the courses and outcomes of the index patients revealed that more than half of them had protracted courses of treatment (more than a year after the start of treatment). Although antidepressant medication was effective to some degree for all of the patients, mild or moderate depressive symptoms remained for a long period in patients with protracted courses of treatment. However, many such patients completely remitted soon after they returned to their former position (or moved to a desired position).(ABSTRACT TRUNCATED AT 400 WORDS)
Kunugi
H
H
Department of Psychiatry, Teikyo University School of Medicine.
D000328:Adult; D003866:Depressive Disorder / Q000523:psychology* / Q000628:therapy; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008393:Marriage; D008875:Middle Aged; D010559:Personnel Management; D012737:Sex Factors; D013406:Suicide, Attempted