Research reportDefining guilt in depression: a comparison of subjects with major depression, chronic medical illness and healthy controls
Introduction
The symptom “feelings of guilt” is a central feature of major depression. This symptom appears in the diagnostic criterion sets for major depression (American Psychiatric Association, 1994, World Health Organization, 1992), in depression rating scales (Beck et al., 1961, Hamilton, 1960), in psychoanalytic (Freud, 1917/1957) and phenomenologic conceptualization of depression (Jaspers, 1963). Despite the wide acceptance of this symptom, a central question remains; namely, is guilt specific to depression, or is the guilt in depression simply a part of the experience of having a serious, often chronic, illness? While early studies failed to demonstrate the specificity of guilt in depression as compared to other psychiatric illnesses (Harrow et al., 1966, Harrow and Amdur, 1971, Prosen et al., 1983), more recent studies have found guilt to be one of the most useful discriminating symptoms of depression (Breslau and Davis, 1985, Jarrett and Weissenberger, 1990). Such discrepant findings may be attributable to the earlier methods of measuring guilt. Harrow and Amdur (1971) relied upon a clinician’s subjective rating of whether a patient felt “guilty” or “not guilty” based on a violation of internal moral standards. Others have used rating scales not designed to identify guilt specifically (Breslau and Davis, 1985, Leckman et al., 1984, Nelson and Charney, 1981) or scales that do not distinguish guilt from other related constructs such as shame and hostility (Jarrett and Weissenberger, 1990, Prosen et al., 1983). These earlier inconsistent findings challenge our understanding of guilt in depression, and have led several investigators to highlight the need for further research with operationalized definitions less prone to ambiguity (Berrios et al., 1992, Parker and Sengoz, 1996, Shapiro, 1979). In addition, no study to date has examined the issue of state-guilt (as part of the acute depressive symptomatology) versus trait-guilt (as part of an enduring disposition).
Recent advances in the psychometric measurement of guilt have led to the development of several new validated measures of guilt. In the current study, we have applied these new measures to address the following unanswered questions: (1) Do subjects with depression experience any more guilt than matched comparison subjects with a chronic medical illness or healthy controls? (2) What is the relationship between the severity of depression and the degree of guilt expressed? (3) Is depression associated with state-guilt, trait-guilt or both?
Section snippets
Sample
The depressed sample consisted of outpatients with either a current major depressive episode (MDE) (n=34) or past-MDE currently euthymic (n=22), consecutively recruited from a mood disorders program at a university affiliated clinic. The clinic did not specifically accept referrals based on the presence or absence of any particular symptoms of major depression. Subjects were included if they met criteria for current or past-MDE by the Structured Clinical Interview for DSM-IV (SCID) (First et
Demographic and clinical characteristics
Table 1 presents the demographic and clinical characteristics of the sample. There were no significant gender differences between groups. The cardiac group was significantly older compared to the other groups (F=14.2, df=3:131, p<0.0001). 17-item Ham-D scores demonstrated significant differences between each group in the expected direction (F=263.2, df=3:130, p<0.0001). GAF scores differed among the groups, with current-MDE patients having significantly lower GAF scores than past-MDE patients,
Discussion
Results from the GI indicate that depressed subjects (current and past) experience more state- and trait-guilt compared to cardiac and healthy controls. Although current depressed subjects experience more state-guilt than past depressed, there is no significant difference in the expression of trait-guilt. Subscription to moral principles appears similar across all groups, whether depressed or not. Results of the SSGS reveal state levels of shame, guilt and pride differentiate acutely depressed
Acknowledgements
Funding by a Physicians’ Services Incorporated (PSI) Foundation grant No. R98-06.
References (27)
- et al.
Refining DSM-III criteria in major depression: an assessment of the descriptive validity of criterion symptoms
J. Affect. Disord.
(1985) Conceptual and methodological issues in the assessment of shame and guilt
Behav. Res. Ther.
(1996)Diagnostic and Statistical Manual of Mental Disorders
(1994)- et al.
An inventory for measuring depression
Arch. Gen. Psychiatry
(1961) - et al.
Feelings of guilt in depression: conceptual and psychometric aspects
Br. J. Psychiatry
(1992) - et al.
The Practical Formulation of Suicide Risk
(1983) - et al.
Reliability of depression and associated clinical symptoms
Arch. Gen. Psychiatry
(1983) - et al.
Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure
Psychopharmacol. Bull.
(1993) - et al.
Structured Clinical Interview for Axis I DSM-IV Disorders – Patient Edition (SCID-I/P, Version 2.0)
(1994) Mourning and melancholia
A rating scale for depression
J. Neurol. Neurosurg. Psychiatry
Symptomatology and subjective experiences in current depressive states
Arch. Gen. Psychiatry
Guilt and depressive disorders
Arch. Gen. Psychiatry
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2020, Organizational Behavior and Human Decision ProcessesCitation Excerpt :Experiencing too much guilt and shame can be detrimental, both to the employee and the organization. These emotions weigh heavily on people, even leading to depression and other clinical disorders (e.g., Andrews, Qian, & Valentine, 2002; Cohen et al., 2011; Ghatavi, Nicolson, MacDonald, Osher, & Levitt, 2002; Tangney, 1995). For instance, soldiers reporting high levels of guilt after combat exposure were more likely to suffer from posttraumatic stress disorder (Owens, Steger, Whitesell, & Herrera, 2009).