J. psychrar. Res., Vol. 27. No. I, pp. 3-10,
Printed in Great Britain.
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0022%3956/93 $6.00 + .oO
Pergamon Press Ltd
SIZE AND DEPRESSIVE SYMPTOMS
JEWISH WOMEN
KATE
Psychology
1993
MIRIAM
Department,
Royal
(Received
LOEWENTHAL*
and VIVIENNE
Holloway and Bedford New College
Surrey TW20 OEX, U.K.
18 September
IN ORTHODOX
GOLDBLATT
(London
1992; revised 27 November
University),
Egham,
1992)
Summary-Family
size, religiosity and contextually-assessed
stress were examined in relation to
I1 symptoms of depression in Jewish women. Some indices of family size related to the absence
of some symptoms. Notably, having pre-adult children was associated with absence of hopelessness.
Religiosity and family size were highly confounded
but the effects of the two did differ. Religiosity
related to the absence of several symptoms:
these were generally different from the symptoms
associated with low family size. The data show that the associations between family size and religiosity,
and depressive symptoms,
cannot be explained in terms of lowered levels of stress.
Introduction
RELATIONSHIP
of childcare to depression in women involves conflicting
effects. On
the one hand is the widely-cited finding of Brown and Harris (1978) that caring for several
young children may interact with stress (a provoking agent) to produce a depressive illness.
Brown and Harris (1986) suggest this is due to the covariation
of low self-esteem and
helplessness with caring for several young children, in the particular
group of women
studied.
The evidence since 1978 suggests that the Brown and Harris finding was a feature of
the cohort studied: subsequent
work has failed to confirm that a number of young or
dependent
children is necessarily a risk or vulnerability
factor for depression.
Studies including total number of children, number of dependent or number of young
children as risk factors for depression include Weissman (1984), Caserta, Lund and Gray
(1987), Calzeroni, Conte, Terzi, Vita and Sacchetti (1989), Loewenthal,
Goldblatt,
Amos
and Mullarkey (1993) and Quinn and Holman (1991). None of these studies showed an
association
between family size and depression.
Calzeroni,
Conte, Pennati,
Vita and
Sacchetti (1990) looked at suicide attempts in patients with major affective disorders, and
reported that suicide attempts were more likely in those with a smaller family size.
Studies looking at family size as a vulnerability
factor in depression include Brown and
Prudo (1981), Costello (1982), Hallstrom (1986) and others mentioned in a review by Brown
and Harris (1989). Much work has confirmed the role of severe life events and/or major
difficulties
in provoking
depression
(and other illnesses), but the vulnerability
factors
proposed by Brown and Harris (1978) have not always been found to be important in other
studies.
THE
*Author
to whom
correspondence
should
be addressed
4
K. M. LOEWENTHAL
and V. GOLDBLATT
Failure to find family size as a risk or a vulnerability
factor for depression may be due
to changing mores. In the 197Os, contraception
and abortion were not as available as in
the 198Os, and it is suggested that work showing no or negative association between family
size and depression reflects situations in which children are positively valued, and in which
their absence may be associated with distress and perhaps depression (Brown & Harris,
1986). Thus, Callan and Hennessey
(1988) summarize
studies showing an association
between infertility and distress measures, and Bart (1976) suggests that depression is a result
of the “empty nest” in mid-life women. Childrearing,
it is suggested, gives identity and
purpose (Lineham, Goodstein,
Nielsen & Chiles, 1983), and is esteemed in many religions,
cultures and sections of society (Loewenthal
et al., 1993).
Differing measures of family size in research often reflect different postulated underlying
effects. The type of measure most widely employed, number of young children, is used
to investigate effects and correlates of active childcare, and of having children in the home,
and/or conversely, effects of children growing up and “leaving the nest”. This measure
has been shown to be associated with depression
in every possible direction (positive,
negative and not at all), for the reasons outlined above. Another measure is whether or
not the subject has children, and this has been used to look at effects and correlates of
having children at all, and conversely,
the effects of infertility,
whether voluntary
or
involuntary.
As mentioned,
involuntary
infertility is found to be quite depressing. A third
measure is the number of children, regardless of age; this measure seems to be unpopular
in societies where ties between children and family of origin are loosened in adolescence,
but has been employed in studies of societies where family ties may remain close (for
example, in Southern European and traditional
Jewish societies). Here, there is evidence
of a negative relationship
between family size and depression,
and the suggestion is that
sheer number of offspring may have a positive effect on status and/or self-esteem.
Depression research has been dominated
by the tradition that depression is a general
state that varies in extent and thus, can be measured in extent. The two most popular
approaches
are
(a) psychometric self-report measures which assess depressed mood (and sometimes selfreport of other depressive symptoms).
Typically, the number of moods (and symptoms)
that the subject reports as being present is taken as a measure of the extent of depression.
Such measures are thought to be useful in looking at subclinical
populations.
(b) The other widely-used approach has been to use a clinical interview to diagnose the
presence of clinical depressive illnesses.
More recently, however, there has been a growing interest in distinguishing
differing
kinds of depressed states and symptoms as worthy of investigation in their own right. Greene
(1989) has argued for a distinction between hopeless and non-hopeless depression. She found
that depressed women with children under 10 had low scores on a measure of hopelessness,
and expressed more positive thoughts about the future, compared to women with no young
children. In line with Greene’s finding is that of Calzeroni et al. (1990), reporting lower
fertility in suicide attempters.
Greene’s approach casts doubt on the universality
of aetiological theories of depression
in which thoughts of worthlessness, hopelessness and the like are said to play a fundamental
role in the genesis of depressive illness. Greene argues that it is time for “a closer look
FAMILYSIZE AND DEPRESSIVESYMPTOMS
5
at the assumed components
of the depressive condition”.
There is a considerable literature
suggesting that the covariation
of depressive symptoms is, indeed, quite loose.
This report, therefore, concerns the “components”
of depression: hopelessness and other
symptoms listed below. We present analyses of some data from a community study of Jewish
women, and we look at hopelessness as well as other components of the depressive condition
in relation to several indices of family size.
The evidence reviewed so far would suggest that, especially when childrearing is valuedas in the case in at least some sections of the Jewish community-there
would be a general
association
between indices of family size and low levels of depression.
The specificity
argument and the evidence proposed by Greene leads to the proposal that this effect would
be particularly marked with respect to hopelessness compared to other depression symptoms.
Since family size and religiosity covary in the groups of women studied, our analyses
attempt to disentangle
the covarying effects of these two factors upon the presence or
absence of specific depression symptoms.
Method
Subjects
The data are from 56 Jewish women, taken from a parent sample of 121 selected at
random from synagogue membership lists. Half the women came from “middle-orthodox”
lists. The parent sample is described
synagogue lists and half from “strictly-orthodox”
more fully in Loewenthal et al. (1993). The strictly-orthodox
norm is to have a large family
size (Kosmin & Grizzard, 1975) (mean of the present sample was 4.5), while the average
number of children in the middle-orthodox
group was 2.1 (unrelated t = 4.14, d.f. = 53,
two tailed p = < .OOl). The inclusion
of women from middle and strictly-orthodox
communities
was to ensure a wide range of family sizes in the study; the range was O-12
children. Half of the women in the present study were the highest-scoring
quartile from
the parent sample on a checklist measure of depressed mood, and the other half were the
lowest-scoring
quartile (the 4 women missing from the quartiles declined to participate in
this part of the research, or could not be contacted).
This aspect of the design was to
maximize the chances of including
at least a number of women with some depression
symptoms in the study, along with women who were unlikely to have any symptoms of
depression. The women, who had already participated in a postal checklist and questionnaire
study (Loewenthal et al., 1993), were contacted by telephone and asked if they would agree
to an extended face-to-face interview. The age range of the women studied was 23-85 (mean
51.2, S.D. = 15.73); 41 (74.5%) were still married and 14 (25.5%) were single, widowed
or divorced.
Measures
The interview
was conducted
in each subject’s home, and included
questions
on
demographic
and other factors, a short form of the Present State Examination
(Wing,
Cooper & Sartorius,
1973) focusing on anxiety and depression symptoms,
and the Life
Events and Difficulties Schedule (LEDS) (Brown & Harris, 1978). The LEDS was modified
6
K. M. LOEWENTHAL
and V. GOLDBLATT
slightly for the target population
by the inclusion
of additional
questions on problems
associated with finding marriage partners. Other culturally-specific
events (e.g. to do with
rites of passage, the religious calendar, or difficulties of religious observance) were elicited
satisfactorily
by existing LEDS questions. Some material on anti-Semitism
emerged in the
present project and it was decided to include specific questions on this and related topics
in later versions of the LEDS to be used with Jewish subjects. Approximately
l/3 of the
events and difficulties reported were considered to be either caused or modified in severity
by the cultural context; rating precedents did not exist in the existing LEDS dictionaries
and were developed in consultation
with Tirril Harris and the MRC rating team.
Our analyses here concern selected depression symptoms-the
so-called Bedford College
symptoms, which are a set of diagnostic criteria for depression developed by Brown and
Harris (1978) prior to the development
of the DSM-III.
Finlay-Jones,
Brown, DuncanJones, Harris, Murphy and Prudo (1980) describe the validation
of these criteria for
diagnosis. The Bedford College criteria resemble those for DSM-III major depression, and
we collected dates of onset and offset for these symptoms.
This report concerns those
symptoms and measures of family size that applied at the time of interview.
The symptoms were: depressed mood, loss of concentration, brooding, loss of interest,
hopelessness, suicide plans, self-deprecation,
retardation.
appetite loss, delayed sleep, early waking,
A number of anxiety and tension symptoms were assessed but will not be examined here.
Some of the possible effects of their being confounded
with depression
symptoms
are
examined elsewhere (Loewenthal
& Goldblatt,
in preparation).
Indices of family size were:
l Presence of children under 10 ys (following
Greene, 1989) (mean = 0.91, S.D. = 1.58,
range = O-6);
l Presence
of dependent children (under
18 ys) (mean = 1.78, S.D. = 2.79,
range = O-12);
l Whether S has a large family (4-t children) (mean = 3.20, S.D. = 2.46, range = O-12);
l Whether children at all 52 women had at least one child; 4 were childless.
Several measures of religiosity (affiliation,
practice, perceived importance)
were taken;
these proved to be highly inter-correlated
and to relate to the other variables to about the
same extent as each other, and so just one is reported in the present analyses: orthodoxy
of synagogue affiliation.
The Life Events and Difficulties Schedule (LEDS; Brown & Harris 1978), slightly modified
for use in the Jewish context, as described, was used to yield two measures of stress:
(a) whether or not a provoking agent (severe event or major difficulty) had occurred in
the 2 ys prior to the interview;
(b) number of all life events (including non-severe) and difficulties (including non-major)
in the 2 ys prior to interview.
Results
Table 1 presents the results of loglinear analyses (following West, 1991) showing the
associations
between family size indices, religiosity and depression symptoms.
Loglinear
1.
FS&D
<I
1.9
<I
<I
2.P
1.4
<I
<I
<I
<I
1.4
R&D
4.2*
<1
<l
6.8**
<I
5.2s
<I
<I
<I
6.5**
3.8*
FS&R
10.99***
13.0***
12.3***
12.5***
12.2***
13.6***
12.5***
12.3***
10.7***
8.8***
13.6***
FS&D
<1
<I
2.4’
<I
3.6*
<1
<I
<I
<I
1.2
1.2
Index of family size and composition
having children < 30,
having
R&D
5.5*
<I
< I
1.3*+
<I
3.8*
<I
<I
<1
5.5*
3.7*
children
FS&R
13.6***
13.8***
14.1***
14.3***
13.7***
13.5***
13.9***
14.0***
11.5***
9.2**
14.7***
< 18,
FS&D
<I
1.8
1.8
1.2
<l
<I
<I
<I
<1
2.3’
<I
having
R&D
5.3*
<I
<I
3.7*
<I
2.2X
<I
<l
<I
11.7***
1.8
4 + children
FS&R
14.0***
14.7***
14.7***
11.5***
14.1***
12.6***
13.9***
14.3***
19.9***
16.0***
13.5***
FS&D
1.2
2.3*
1.9
1.6
<I
<I
1.2
1.7
1.8
2.8’
<I
havine
R&D
6.4**
<I
<I
7.3+*
<I
2.1x
<I
<I
<1
7.0**
2.0
children
FS&R
6.1**
5.4*
5.2*
5.9*
5.1*
4.1*
5.4*
5.5*
5.8*
2.3’
4.6*
at all
_
_
_
Notes. (1) All chi-squares here are with 1 d.f. (2) No three-way interactions (between family size, religion and symptom) were significant.
Abbreviations: (1) FS = family size and composition,
R = religiosity, D = depression symptom, (2) ’ p < .I; * p < .05; ** p < .Ol; *** p < ,001.
Depression
Loss of concentration
Brooding
Loss of interest
Hopelessness
Suicide plans
Self-deprecation
Appetite loss
Delayed sleep
Early waking
Retardation
Symptom
Loglinear Analyses: Partial Chi-squares and Significance of the Two-way Associations Between Family Size, Religiosity and Specific Depression Symptoms
Table
8
K. M. LOEWENTHAL and V. GOLDBLATT
analyses partition the chi-square, indicating the strength of the association between different
variables, with other variables controlled.
Associations
are all in the direction that family
size and religiosity are associated with fess likelihood of symptoms. Lowered hopelessness
was associated with having dependent children. There were also associations between some
family size indices and absence of early waking, loss of concentration
and (marginally)
brooding.
It will be seen from Table 1 that family size is strongly associated with religiosity.
However, it is also apparent that the associations
between religiosity and the different
depression symptoms are quite different from those between family size and the depression
symptoms. Religiosity goes along with absence of: depressed mood, loss of interest, suicide
plans, early waking and retardation.
There are possibly confounding
effects of stress. The more religious may well have less
stressful and more “protected”
lives (Prudo, Harris & Brown, 1984). The first stress
measure, presence of a provoking agent, showed no association with any measure of family
size (Table 2), or with religiosity (x2 = 1.1, d.f. = 1, ns). The second measure, number
of events and difficulties, was weakly but significantly associated with each of the measures
of family size studied (Table 2) but not with religiosity (t = 1.44, ns). The significant
associations
between stress and family size were in the direction that women with larger
families reported more events and difficulties
(Table 2).
Thus, the absence of certain symptoms associated with family size and religiosity cannot
be accounted
for in terms of lowered levels of stress.
Table 2.
Correlations Between Measures of Stress and Family Size
Provoking
agent
Number of events
and difficulties
Number of young
children (under
10 ys old)
Number of dependent
children (under
18 ys old)
Total number
of children
- .02
.05
.02
.35***
.40***
.31**
** p < .Ol, *** p < ,001.
Discussion
Family size covaries strongly with religiosity, but our analyses have eliminated spurious
effects, leaving us with patterns of associations
with depressive symptomatology
that are
quite different for the two factors. However, both are associated with lowered levels of
symptoms.
The salient feature of the associations between family size and depressive symptomatology
is the association between caring for young (and adolescent) children, and low hopelessness.
Low hopelessness is not associated with large family size or having children at all. Greene
(1989) suggested that childcare facilitates hopeful thoughts about the future, and our data
bear this out, with the modification
that, in this cultural context where ties between parents
and adolescents are strong, the effect extends from those with children under 10 ys to those
with children under 18.
FAMILY SIZE AND DEPRESSIVE SYMPTOMS
9
Of the other associations
between family size and depressive symptomatology,
we note
that those with children under 18 ys are less likely to brood, whilst those with no children
at all (a very small number of women) are more likely to describe loss of concentration
and early waking. Early waking is the only symptom more likely to occur in women with
smaller families than women with larger families. The early waking effects may be the results
of changing sleep habits and attitudes to sleep resulting from parenting.
The effects on
cognitive processes may be the result of tighter time-and-attention
budgeting, again resulting
from parenting.
In all, the effects of family size in these groups of Jewish women seem to be those that
are the result of parenthood
as such, rather than of having many children. The effects
are generally rather weak, but deserve further research attention.
The effects of religiosity are somewhat stronger-and,
as stated, are quite distinct from
those of having children. Absence of: depressed mood, loss of interest, suicide plans, early
waking and retardation,
are all associated with religiosity. This constellation
points to a
higher level of zest for life-alternatively,
a lower level of disillusion,
among the more
religious. There are some supportive suggestions in the literature. Paloutzian (1981) indicated
that religiosity
might be related to feelings of purpose.
Suicide is generally strongly
discouraged
in Jewish religious thought. The more devout subjects in this and related
projects report that they use religiously encouraged anti-depressant
cognitions (Loewenthal,
1992). However, the specific effects of religiosity on the cognitive processes thought to
be important
in depression and other psychiatric conditions
remain to be investigated.
Finally, we turn to the possible confounding
effects of stress. Prudo, Harris and Brown
(1984) suggested that the more traditional
churchgoing
women in their Hebridean sample
were less likely to be depressed because their lifestyle involved them in less stress (lowered
likelihood of provoking agents) and also that churchgoing
acts as a protective factor in
its own right. Some of the protective aspects of religiosity have already been discussed above.
In our analyses, family size and religiosity go along with similar or raised levels of stress,
so that the association
between family size and religiosity on the one hand, and lowered
distress-hopelessness,
depression and so on, on the other-cannot
be explained in terms
of lower levels of stress.
Our evidence, from the two groups of Jewish women studied, suggests that family size
and religiosity might have specific effects on components
of depression which cannot be
explaned in terms of covarying stress levels. These effects deserve closer investigation.
Acknowledgements-Thanks
are due to the Nuffield Foundation
for financial support of this project, and to
many members of the Jewish community
for their interest, encouragement
and help: Rabbis J. H. Dunner,
S. Lew. M. Posen, Lady Amelie Jakobovits and many others. From the Psychology Department at Royal Holloway
and Bedford New College particular thanks are due to Rosemary Westley, for constant support, to Andy MacLeod
for his interest and helpful ideas, to Bernice Andrews for discussion of several aspects of the research and analyses,
and to John Valentine for his never failing patience in discussing problems of statistics and analysis. Last, but
definitely not least, thanks go to Tirril Harris for training and many hours discussing the project and the coding
of life events.
References
Bart, P. B. (1976). Portnoy’s
New York: Schocken.
mother:
depression
in middle-aged
women.
In E. Koltun (ed.), The Jewish Woman.
10
K. M.
LOEWENTHAL
and V.
GOLDBLATT
Brown, G., & Harris, T. 0. (1978). The social origins of depression. London: Tavistock.
Brown, G. W., & Harris, T. (1986). Stressor, vulnerability and depression: a question of replication. Psychological
Medicine, 165, 139-744.
Brown, G., & Harris, T. 0. (eds.) (1989). Life even& and illness. London: Unwin Hyman.
Brown, G., & Prudo, R. (1981). Psychiatric disorder in an urban and a rural population
1: aetiology of depression.
Psychological Medicine, 11, 58 l-599.
Callan, V. J., & Hennessey, J. F. (1988). The psychological
adjustment of women experiencing infertility. British
Journal of Medical Psychology,
61, 137-140.
Calzeroni, A., Conte, G., Pennati, A., Vita, A., & Sacchetti, E. (1990). Celibacy and fertility rates in patients
with major affective disorders: The relevance of delusional symptoms and suicidal behaviour.
Acfa f.yychiatry
Scandinavica,
82, 309-3 10.
Calzeroni, A., Conte, G., Terzi, A., Vita, A., & Sacchetti, E. (1989). Fertility and marital status in mood disorders.
New Trends in Experimental
and Clinical Psychiatry,
5, 87-90.
Caserta, M. S., Lund, D. A., & Gray, R. M. (1987). Vulnerability
factors and depressive symptoms among
hospitalized
women. Journal of Community
Psychology,
15, 216-227.
Costello, C. G. (1982). Social factors associated with depression: a retrospective community study. Psychological
Medicine, 12, 329-339.
Finlay-Jones,
R., Brown, G., Duncan-Jones,
P., Harris, T. O., Murphy, E., bt Prudo, R. (1980). Depression
and anxiety in the community:
replicating
the diagnosis of a case. Psychological Medicine, 10, 445-454.
Greene, S. (1989). The relationship
between depression and hopelessness.
British Journal of Psychiatry,
154,
650-659.
Hallstrom,
T. (1986). Social origins of major depression: the role of provoking agents and vulnerability
factors.
Acta Psychiatrica Scandinavica,
73, 383-389.
Kosmin, B., & Cirizzard, N. (1975). Jews in an inner London Borough-Hackney.
London: Board of Deputies
of British Jews.
Lineham, M., Goodstein,
J. L., Nielsen, S. L., & Chiles, J. A. (1983). Reasons for staying alive when you are
thinking of killing yourself: the reasons for living inventory. Journal of Consulting and Clinical fsycho/og_v,
51, 276-286.
Loewenthal,
K. M. (1992). Melancholy,
depression and Judaism.
Internatronal Journal for the Psycholog_v o,f
Religion, 2, 101-108.
Loewenthal,
K. M., Goldblatt,
V., Amos, V., & Mullarkey,
S. (1993). Some correlates of distress in AngloJewish women. In L. Brown ted.), Religion, culture and mental heal/h. New York: Springer-Verlag
(in press).
Paloutrian,
R. F. (1981). Purpose in life and value changes following conversion.
Journal of Personality and
Social Psychology,
41, 1153-l 160.
Prudo, R., Harris, T., & Brown, G. (1984). Psychiatric
disorder in an urban and in a rural population.
3: Social
integration
and the morphology
of affective disorder. Psychological Medrcine, 14, 327-345.
Quinn, J. F., & Holman, J. E. (1991). lntrafamilial
conflict among felons under community supervision. Journal
of Offender Rehabilitation,
16, 177-192.
Weissman, M. (1984). Onset of major depression in early adulthood:
increased familial loading and specificity.
Archives of General Psychiatry,
41, 1136-l 143.
West, R. (1991). Computing for psychologrsts.
London: Harwood.
Wing, J., Cooper, J., & Sartorius, N. (1973). The measurement and classification of psychiafric symptoms. I.ondon:
Cambridge
University Press.