Research reportEffects of social support during weekend leave on cortisol and depression ratings: a pilot study
Introduction
The sensitivity of the hypothalamic–pituitary–adrenal axis to environmental effects suggests a mediating role in depression (Calloway and Dolan, 1989). Similar psychosocial factors affect both corticosteroid secretion in animals exposed to chronic stress and the course of depression in humans (Checkley, 1996). The protective effect of social support in reducing vulnerability to depression may act by alleviating the endocrine response to environmental stress including hassles (minor daily events; Nicolson, 1992).
The pulsatile pattern of cortisol secretion resulting in diurnal variation in levels, and sensitivity to stress, requires hourly cortisol measurements for accurate estimation of cortisol secretion. The acute stress response commences within a few minutes of a hassle, and lasts an hour. Salivary measurement provides an accurate indication of the free hormone (Kirschbaum and Hellhammer, 1994). Hourly measurement would reflect a hassle that has occurred in the previous hour.
Inpatient admission enables hospital and home to be compared in terms of depression, social support and cortisol levels. Weekend leave is used to prepare for discharge and to assess the robustness of improvements made. Across ward and home settings hypotheses were that differences in social support ratings will be negatively associated with (1) differences in depression ratings and (2) differences in cortisol levels. An additional hypothesis was that cortisol levels will be positively associated with the experience of hassles.
Section snippets
Method
Subjects were inpatients in the Affective Disorders Unit of the Bethlem and Maudsley Hospitals with DSM IV (American Psychiatric Association, 1994) diagnoses of major depressive episode.
The following measurements were taken on 2 days — (1) 1 weekday on the ward before the weekend leave and (2) 1 day during the weekend leave:
(i) The Montgomery Asberg Depression Rating Scale (MADRS; Montgomery and Asberg, 1979).
(ii) Salivary cortisol using the ‘salivette’ (Sarstedt, Leicester). Subjects made
Sociodemographic characteristics
The mean age was 49.1 years (S.D. 11.6; range 24–65). 14 (61%) of subjects were male; 18 (78%) were married or cohabiting; and 15 (65%) were employed.
Depression
The mean MADRS score on the ward was 16.9 (S.D. 8.8; range 4–38), and at home was 15.0 (S.D. 7.6; range 3–29).
Crisis support
Eleven subjects (48%) were able to elicit crisis support on the ward, and 13 (57%) at home. Seven subjects (30%) were able to elicit crisis support in both settings, 10 subjects (44%) in one, and six subjects (26%) in neither.
Cortisol
The
Feasibility of obtaining data
The characteristic pattern of the diurnal decline in cortisol and the high correlation between ward and home values demonstrate that depressed patients can accurately collect timed saliva samples both on the ward and on weekend leave. The study also shows that it is possible to measure social support provided by a ward setting.
Social support findings
There was a linear relationship between changes in depression scores across different levels of crisis support. The stratified analysis of the 10 subjects with crisis
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