title: Lack of coordination of nonverbal behaviour between patients and interviewers as a potential risk factor to depression recurrence: vulnerability accumulation in depression.
abstract: BACKGROUND
  Coordination of nonverbal behaviour during interactions is a prerequisite for satisfactory relationships. Lack of coordination may form a risk factor for depression. The 'vulnerability-accumulation hypothesis' assumes that vulnerability to recurrence of depression will increase with increasing experience of depressive episodes. Therefore it is expected that interviewers and patients remitted from a recurrent episode of depression would reach less coordination during a clinical interview compared to interviewers and patients remitted from a first lifetime episode. Moreover, we assumed that prior severity of depression modifies this reciprocal coordination process.
  
  
  METHODS
  During discharge interviews, interviewers were videotaped in interaction with remitted patients with unipolar major depression recurrent depression (REC); n=28; first episode (SEP); n=22. Durations and frequencies of nonverbal involvement behaviour was registered during the first 15 min. Involvement of the patients consisted of gesticulating, looking at the interviewer, and general head movements; yes--nodding and hm, hm, yes, yes reflected involvement of the interviewer. Coordination between patients and interviewers was analyzed per 3-min epochs and defined as 'attunement': the absolute difference between patients' and interviewers' involvement. Averaged attunement, its time course and variability (presumably reflecting control of the attunement process) were assessed.
  
  
  RESULTS
  The time course of nonverbal attunement differed between the REC and SEP condition. A larger variability of attunement was found in patients remitted from a relatively severely depressed episode, compared to patients remitted from a severe first life time episode. No other significant differences were found.
  
  
  CONCLUSIONS
  Partial support was found for the notion that nonverbal vulnerability accumulates in depression and that the severity of prior depression modifies this process.
authors.affiliation: Academic Hospital Groningen, Department of Social Psychiatry, Hanzeplein 1 9713 GZ, Groningen, The Netherlands. a.l.bouhuys@med.rug.nl
authors.forename: A L
authors.initials: AL
authors.lastname: Bouhuys
authors.forename: M M
authors.initials: MM
authors.lastname: Sam
mesh_terms: D000328:Adult; D001519:Behavior; D003865:Major Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009633:Nonverbal Communication; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors