Table 2.

Examples of case vignettes scored at each level of understandability^a

Rating of 1, not understandable

The respondent (R), a 39-year-old married man, had an 8-month episode of MD that he attributed to the purchase of a car that turned out to have a lot of problems. The only past-year stressful life event occurring before the onset of the MD was the major new expense of this car purchase, followed by several months of trying unsuccessfully to get the dealer to repair it or allow him to return it. R indicated his family has ‘more money than we need’ and never has trouble affording things. No particular stress was reported at his job of 9 years as a sales manager. His relationships with his wife, other family members and friends are quite good.

R is a 34-year-old married woman with three school-age children. She had a 9-week episode of depression which she said came ‘out of the blue.’ Very good relationships with spouse, children, other family members and friends were reported. Her job of 9 years as a nurse is secure and only moderately stressful; she reported an expected reorganization of responsibilities at work a few months before her MD onset (minor long long-term contextual threat (LTCT)). The only other past-year stressful life events she reported all occurred several months before her MD onset and all were rated minor LTCT—major new expenses related to her husband starting a business, an uncle’s expected death and sibling’s and friend’s personal crises.

Rating of 2, a little understandable

R is a 47-year-old never-married man, living with his partner and her 21-year-old son, who had a 2-week episode of past-year MD when his partner entered the hospital for minor gallbladder surgery. R’s job was described as fairly highly pressured but secure; finances are tight and his partner does not work outside the home. He reported having an excellent relationship with his partner (his one confidant) and good relationships with six friends as well as family members. No other past-year stressful life events were reported.

R is a 42-year-old never-married woman living with a partner for the past 2 years. She reported a 3-week episode of past-year MD starting just after the new year, which she related to fatigue and overload from work and the holidays. She owns several retail stores and works 60+ hours per week. Past-year stressful life events reported—all rated minor or low moderate LTCT—were difficulty getting along with a subordinate (7 months before MD onset), an employee died of colon cancer (3 months before MD), her car was burglarized (3 months before MD); and her sister had a personal crisis (same month as R’s MD onset). Her relationship with her partner was described in positive terms, although he is not one of her two confidants. She reported very good relationships and frequent contact with five friends but not especially close relationships with family members.

Rating of 3, somewhat understandable

R is a 46-year-old married woman with one biological and two step-children. She reported an ongoing 8-month episode of past-year MD attributed to conflict with daughter and concern over a cyst in her breast (not coded in health section, just mention of fibrocystic breast disease there). The month before the MD onset, R started having serious trouble getting along with her daughter, who got mixed up with the ‘wrong crowd,’ flunked out of college, and moved back home (high moderate LTCT). This was also a serious personal crisis for her daughter (low moderate LTCT). That same month R had financial problems (minor LTCT); reportedly her family has ‘not enough’ money. She indicated she has fairly good relationships with her husband (although he is quite a bit demanding and there is some tension and criticism) and her children (although they often are too dependent, argumentative, do not pay enough attention and do not listen enough), good relationships with two friends and fair relationships with relatives.

R is a 21-year-old full-time college junior who reported a 2-week episode of past-year MD attributed to receiving poor grades (C’s and D’s) in her engineering courses and hating her planned engineering major. She reported the additional component of feeling like she was a failure and letting down her father, an engineer, when she decided to switch to a business major. R has frequent contact with and very good relationships with seven friends and family (although she is ‘afraid’ of her father), has four confidants and attends weekly club meetings. No financial, health or other past-year stressful life events were mentioned.

Rating of 4, quite understandable

R is a 47-year-old married mother of three. Her worst past-year episode of MD, lasting 9 weeks so far, was attributed to ongoing medical problems (hypertension, pinched nerve in back, permanent nerve damage in foot) resulting in > 3 months in bed. The pinched nerve in her back occurred at work last winter and has worsened over time, aggravating her preexisting foot problem, and eventually causing her to take sick leave starting 2 months before the MD onset. Her activities have been greatly limited and she has been in great pain (severe LTCT). She expects to be out of work for 6–12 months and so far has been unpaid due to slow paperwork processing, resulting in a major reduction in family income (high moderate LTCT). R described her marriage in mostly negative terms and reported serious trouble getting along with her husband (high moderate LTCT). She said her children are often too demanding and dependent and she has had serious trouble getting along with a son (high moderate LTCT). She also reported serious trouble getting along with her mother (high moderate LTCT). In contrast, she has very good relationships with six friends and other family members, with two confidants (not her husband).

R is a 44-year-old married man with a teenage son who reported a 3-month episode of past-year MD, attributed to his dad’s stroke of 2 months earlier ‘sinking in.’ R’s 72-year-old father had been in good health when he had a serious stroke resulting in permanent nursing home placement. R had worked with his father in the family business on a daily basis and the stroke took away a main confidant of R’s and significantly altered his daily routine (severe LTCT). His father’s stroke was also a serious personal crisis for R’s twin and three other siblings (all rated minor LTCT). R reported having an excellent relationship with his wife (a confidant) and very good relationships with his son, 10 friends and family members. No work, financial, health or other past-year stressful life was reported.

Rating of 5, completely understandable

R is a 45-year-old married man with three children. He reported a 6-month ongoing period of MD starting when his 11-year-old daughter was diagnosed with a rare and life-threatening cancer (severe LTCT). His daughter and wife have been living in another city for several months while his daughter receives experimental treatment; she has been close to death several times. R also has had major new expenses related to his daughter’s illness (high moderate LTCT) and he described his family as being poor (R’s reported income confirms this). R’s wife (low moderate LTCT), son (minor LTCT) and cotwin (minor LTCT) all had serious personal crises related to his daughter’s illness. Also in the past year R’s father-in-law died (low moderate LTCT). R reported very good relationships with his wife (his sole confidant) and children, and good relationships with four friends and other family members.

R is a 26-year-old single woman working as a sales representative and living alone. Her worst episode of past-year MD lasted 3 weeks after her partner committed suicide. She had been dating this man for 7 years, they lived together, but she had recently been trying unsuccessfully to extricate herself from this longstanding relationship. R returned home from work 1 day to find her boyfriend hanging from a tree in the backyard. His death also resulted in a major reduction in family income as he had been sharing living expenses; R has ‘not enough’ money. She called the police that month when her boyfriend’s family, who blamed her for his suicide, came into her home to take his things. R reported having good relationships with three friends and family members, with five confidants.

Abbreviation: MD, major depression.

^aSmall changes in details have been made in all these vignettes to protect the identity of the respondent.