A longitudinal study of interaction patterns of a psychiatrist and severely depressed patients based on observed behaviour: an ethological approach of interpersonal theories of depression.

Observed behaviour of a psychiatrist interacting with severely depressed patients during an interview was related to the course of depression during hospitalization. The behavioural structure of such interaction could be described by 6 factors for the patients and 7 factors for the psychiatrist. The study focuses on the psychiatrist's behaviour. The severity of depression and the level of the behaviour factors were assessed just after admission (drug-free) and 10 weeks later. Patients were divided a posteriori into non-improved patients (N = 13) and improved patients (N = 18). The psychiatrist displayed low levels of 'active-listening' (intensive body touching and other hand movements during listening) and showed a tendency to more 'encouragement' by use of remarks such as hm, yes, and head-nodding) in his interaction with patients who did not improve. These factors did not change over time, suggesting that they may play a role in the maintenance of depression. They are supposed to express involvement, and probably indicate psychiatrist's giving support to the support-seeking patients. At the same time the psychiatrist exhibited an aversive response to the non-improved patients, by showing higher frequencies of looking away during his encouragement. The results provide support for interactional theories on depression and illustrate the possible value of an ethological approach in the study of interactional processes.