Stressful life events and passive behavioral patterns in women with major depressive disorder: a mixed method analysis nested in a clinical trial

Abstract

Abstract Background Women are more vulnerable to presenting with major depressive disorder (MDD) as they seem more sensitive to stressful life events (SLE). Few studies describe the effect of SLE on the development of avoidant/passive behavioral patterns (PBP) of MDD. Understanding the relationship between SLE and PBP is essential for the clinical management of MDD. Here, we aim (1) to describe and categorize the perceptions about SLE, emotional experience, and PBP in women with MDD and (2) to discuss the PBP according to evolutionary and behavioral processes. This mixed-method study, including qualitative and quantitative analyses, was nested in a clinical trial with 76 patients. We selected a sample of 18 female patients, randomized to behavioral activation therapy (BAT). In the first sessions, we interviewed the patients about SLE, emotional experience, and PBP perceived during their current depressive episode. The reports were submitted to content analysis and categorized under similar themes. We performed bivariate Spearman correlations to test the strenghts of associations  between depressive symptoms (HAM-D), anxiety symptoms (BAI), disability (SDS), and cognitive distortions (CD-Quest). Results In our sample, the most frequent SLE were romantic relationship problems and family problems. The patients most reported emotional experiences were sadness, discouragement, and anxiety. The most common PBP categories were getting isolated, stopping doing activities, and ruminating. Conclusions Women frequently perceive interpersonal, family, and affective problems as triggers of depressive episodes. The most common passive patterns include isolation, stopping doing activities, and ruminations. The evolutionary functions of PBP are to keep the organism passive, avoiding energy expenditure, and risk exposure in the face of a chronically stressful environment with few opportunities for reward.