Interpersonal styles in major and chronic depression: A systematic review and meta-analysis

McCullough's (2000) theory of chronic depression posits that a hostile-submissive interpersonal style distinguishes chronically depressed individuals from those with Major Depressive Disorder (MDD). This study sought to determine to what extent hostility and submissiveness feature in MDD, and whether there is evidence for a stronger effect in chronic depression.

A systematic literature search was conducted for research measuring the relationship between depression and hostility and/or submissiveness. A meta-analysis was carried out to determine the strength of the relationship. Separate analyses were conducted for the effects of hostility, submissiveness, and hostile-submissiveness. Subgroup analyses were performed comparing the effect sizes of chronic depression and MDD.

Twelve studies met criteria for inclusion. Subgroup analyses revealed large effect sizes for submissiveness (d = 0.86) and hostile-submissiveness (d = 0.93) in chronic depression, and a medium effect for hostility (d = 0.72). MDD was associated with medium effects for hostility (d = 0.58) and hostile-submissiveness (d = 0.63), and a small effect for submissiveness (d = 0.40).

The review yielded a small number of papers, particularly in relation to chronic depression. The majority reported secondary analyses using baseline samples of intervention trials, with normative data as controls. Quality scores were generally low, and analyses revealed high heterogeneity, which may indicate differences between clinical populations studied.

The review provides preliminary evidence that individuals with chronic depression are more hostile-submissive than those with MDD. Results highlight the limited research into interpersonal correlates of chronic depression.