Received: February 20, 2006
Accepted: March 11, 2006
Ref: Mueen B, Khurshid M, Hassan I. Relationship of Depression and Assertiveness in Normal Population and Depressed Individuals. Internet Journal of Medical Update 2006 Jul-Dec;1(2):10-17.

RELATIONSHIP OF DEPRESSION AND ASSERTIVENESS IN NORMAL POPULATION AND DEPRESSED INDIVIDUALS

Ms. Bushra Mueen^†, Ms. Maryam Khurshid^‡ and Dr. Ishtiaq Hassan^Ø

^†Department of Applied Psychology, Institute of Management Sciences, Bahauddin Zakariya University, Multan, Pakistan
^‡National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
^ØSSMS Adaptive Research, Sargodha, Pakistan

(Corresponding Author: Ms. Maryam Khurshid M.Phil, National Institute of Psychology, Center of Excellence, Quaid-i-Azam University, Islamabad, Pakistan, Email: maryam_khurshid1@hotmail.com)

INTRODUCTION

Depression has been recognized as a clinical syndrome for over 2,000 years, but no satisfactory explanation of its puzzling and paradoxical features has been found. Depression in our daily life includes negative feelings, such as sadness, weakness, disappointment, frustration, despair, helplessness and hopelessness. When depressed individuals are confronted with a problem, they don’t seem to find any solution for that problem. They find every moment heavy and their heads fill and reverberate with self-recrimination. They neglect personal hygiene and appearance, make numerous hypochondriac complaints of aches and pains that have no physical basis. They may feel apprehensive, anxious, dejected without any hope and despondent most of the time. When depression becomes chronic, the patient does not always snap back an earlier level of functioning [1].

According to Wolman’s dictionary of Behavioral Sciences [2], depression is a feeling of helplessness and blaming oneself for being helpless. Depression is a self-directed usually associated with hatred directed toward others. Depression is endogenous when it comes from within and it is exogenous when it is a reaction to misfortunes. It is an emotional dejection greater and more prolonged than that warranted by and objective reason and a low state of vital powers or functional activity, dejection, sadness and gloom. It is negative self-concept that is associated with self-approaches and self-blame, e.g., regressive and self-punitive wishes, and desire to escape, hide or die. Vegetative changes are anorexia, insomnia, and loss of libido and a change in activity level retardation or agitation.

Data on the prevalence of depression indicate dramatic gender imbalance. Almost 70% of the individual with major depression are women [3]. Women are more prone to depression because of the effects of hormones. It has also been found that women do not show recovery from depression like most men do [4]. Women tend to ruminate more about their situation and blame themselves for being depressed. Men tend to ignore their feelings, perhaps engaging in activity to take their minds off them [3].

Sociologists and mental health professionals are finding that assertiveness is usually displayed in certain circumstances (i.e. assertiveness is not a personality trait, which persists consistently across all situations). Different individuals exhibit varying degrees of assertive behavior depending on whether they are in a work, social, academic, recreational or relationship context [5]. Assertiveness is defined as behavior which enables people to act in their own best interest by expressing their thoughts and feelings directly and honestly. Assertive behavior is interpersonal behavior involving the honest and relatively straight forward expression of thoughts and feelings. Assertion is a behavior which enables a person to act in his/her best interests, to stand up for herself/himself without undue anxiety, to express honest feelings comfortably or to exercise personal rights without denying the rights of others [6].

Assertiveness is very different from aggressiveness. Aggressiveness involves expressing our thoughts, feelings, and beliefs in a way that is inappropriate and violates the rights of others. It can be either active or passive, but no matter which, it communicates an impression of disrespect. By being aggressive, we put our wants, needs, and rights above those of others. We attempt to get our way by not allowing others a choice. Where assertiveness tried to find a win-win solution, aggressiveness strives for a win-lose solution: I will be the winner; you will be the loser [7].

Four dimensions of definitions in the professional literature have been found. These dimensions include (a) concern with rights, with the poles defined as others and self, (b) “expressing all feelings” to “expressing without undue anxiety and guilt” (c) “socially appropriate self-expression”, and (d) minimizing negative consequences from others [8]. Self-assertiveness results from a continuous, reciprocal interaction between the person’s multidimensional skills and the specific factors involved in the situation. This interaction leads to the development of the subjective expectation about the consequences of the assertive behavior. Individual’s subjective expectancy about the probability of various positive and negative consequences resulting from assertive acts influences a person’s intent to behave assertively. Social skills training has a strong, positive impact on behavior measure of social skill, self-rated assertiveness, and hospital discharge rate, and a moderate impact on relapse rate, when behavioral measures were taken. Training appeared to have the positive impact on the schizophrenics’ perception of themselves. They became more assertive and less socially anxious. The data supported generalization and maintenance of skill gains. However, effects are only marginally significant for broader ratings of symptoms and functioning. Diagnostic homogeneity, the number of techniques used, and training do not appear to be significantly associated with outcome [9].

The assertive behavior should be evaluated within a social and cultural context. Cultural and social norms for behavior are key variables in the definition, training and evaluation of the effectiveness and consequences of interpersonal behavior. The role of social and cultural context is important in assertion training as it enables the assessment and discrimination of behavior appropriate for variety of situations as negative assertion. Recognizing the importance of cultural context in assertion, the goal of assertion training is to have an understanding of assertive behavior in various cultural contexts, to recognize cues that discriminate those different situations, and to build an increased repertoire for responding effectively in each of these contexts. In helping clients make these choices, therapists must avoid implying that there is one best way to behave. Rather, there are more and less effective ways of behaving in different situations [10].

People expect women to behave unassertively. Women may also avoid behaviors that do not fit “the feminine role” and when they do engage in “masculine assertiveness” they are likely to encounter disbelief or even hostility from others. Women tend to be very agreeable because they want to have good social support and they may be hard to achieve consensus. Men’s perception is directed by their needs to achieve success and high social status and this pushes men to take dominant part. They sometimes ignore what has been said before in order to achieve what they want to achieve, and concentrate on making their own points.

Men and Women speak differently [11]. Men tend to be more aggressive speakers than women [12] and women tend to be more polite [13]. Because of these differences women tend to be judged lower in assertiveness than men [14]. The alternate perspective emphasized that powerless speech styles are used by both genders. When one has little control or power over a task, one may become uncomfortable performing the task, and this may end up speaking in a powerless style [15].

The situation of women in Pakistan varies considerably depending upon geographical location and class. To be a woman in Pakistan is to be sensitive, nurturing, overly emotional, easily influenced, and fundamentally dull-witted. Traditionally women also have been expected to allow others to set goals for them rather to initiate their own; to think of others before to avoid positive statements about themselves; and to be willing to help others without expecting the material reward. Gender inequality in a third world country like Pakistan is one of the main factors in hampering the country’s development [16].

The understanding of behavior rooted in our own cultural context is more important in order to avoid the erroneous generalizations based on the assumptions of Western psychology. The psychological knowledge that is native is called the indigenous psychology. Such an approach requires the native principles for definition, classification, and conceptualization of behavior. Indigenous understanding of behavior is needed for the “developed” as well as “developing” and “underdeveloped” countries. Indigenous psychology enables the development of alternate view point of behavior because it emphasizes that there are different ways of being and acting that exist in different cultures, a fact that puts emphasis on the need that every culture must have its own psychology. Indigenous psychology alerts us against the danger of assuming Western psychology as a standard, which lead to the erroneous generalization.

The indigenous psychology is important for studying personality. Global traits do not exist and the greater the cultural variation the smaller the situational comparability. Besides cultural variations there are differences in techniques used for personality assessment. The assessment of personality is also influenced by the cultural differences. It was recognized that cultural differences lie in meaning attached to the situation, communication, and stimuli involved in psychological testing [17]. Cross-cultural differences in objective testing have also been emphasized [18]. Translation, adaptation, and explanation of scales are very common practice in Pakistan. The common feature of these efforts is called “de-centering”. De-centering results in lack of content equivalence. Thus, culturally appropriate tools are more superior for measuring personality. The indigenous psychology for self-assertiveness in Pakistan is important.

An assertive person is one who acts in his/her own best interests, stands up for oneself, expresses feelings honestly, is in charge of self in interpersonal relations, and chooses for self. The basic message sent from an assertive person is “I'm OK and you're OK” [5]. If one is assertive, one can protect oneself from being victimized and taken advantage of by others [19]. If someone is not assertive for his/her own rights then he can not shave himself from regrets in life and this can be significant cause of depression.

Many depressed people are unable to do what they want to do, they do not have courage to live their life according to their own choice and this creates problem when they become unable to do the right action at right time. Then they start having negative self image of themselves and also they take themselves as total failure. This process plays an important role in their depression. That is why in depression assertiveness skills are taught and this is very successful treatment for depressed patients. If you are failing to assert yourself, you may find that other people are not paying attention to your wants and needs. This can be upsetting and humiliating. Learn to express your wishes firmly, but only be confrontational if absolutely necessary. Assertiveness training can be beneficial in learning to do this [20]. People who experience depression habitually often have one or more of the following characteristics: A negative or underdeveloped philosophy of life, low self-esteem, and low assertiveness. The interpersonal skills should add to self-confidence and encourage standing up for one's rights, instead of being submissive. Assertiveness is not fighting; it includes disclosing and expressing emotions, like personal needs and positive feelings, and should deepen relationships. Don't prematurely over-disclose; don't become self-centered or pushy [5].

Depression is an increasing problem of this age. Depression along with non-assertiveness is common in males and females. Rather, assertiveness is a very important cause of depression. An assertive person has fewer chances to be depressed. Assertiveness training has had mixed success with depressives [3]. In our culture assertiveness is studied but not widely explored in relation to depression. Gulnaz Zahid (2003) in Quaid-e-Azam University, Islamabad studied assertiveness in relation to life satisfaction. Her study was simple comparison between males and females. I explored assertiveness in relation to depression.

In Pakistan assertiveness plays significant role in depression. Our culture supports non-assertiveness. Females, especially, are usually non-assertive and depressed. Another cause of non-assertiveness is education. High education makes a person assertive because education makes a person aware of his/her own rights. Present study is to determine the effect of assertiveness on depression. Almost all non-assertive people have regrets, and unfinished businesses in their past life, leading them towards depression.

MATERIALS AND METHODS

Sample

Sample of the present study consisted of 100 subjects. Among them 50 were normal/ non-depressed and 50 were depressed. In each group of 50, 25 were men and 25 were women. The age range of these subjects was between 20-50 years, and education was 8th standard and above. Normal sample was taken randomly from university, colleges, and different job officials (both field job and official job). Depressed people were taken from Nishter hospital, Maryam hospital and C.M.H. Multan.

Instruments

Beck depression inventory (BDI): The BDI is a well-known self-report measure of depression, consisting of 21 items that assess the severity of affective, behavioral, cognitive, and somatic symptoms of depression. Each item is scored on a 3-point scale. Total scores are obtained by adding the items and range between 0 and 63. A number of investigators have confirmed the validity of this measure for use with adolescents [21]. A sensitivity of 100% and a specificity of 93.2% were obtained with a cut-off score of 16 in the selection of a sub sample representative of the adolescent clinical population [21]. An internal consistency coefficient of 0.86 was obtained in this study. In present study BDI-Urdu version was used to measure depression. It comprised of 20 items as its one item having sexual connotation was dropped, so score range of BDI-U is 0-60 and construct validity is 0.84 [16].

Self-assertiveness scale: Gulnaz Zahid developed the scale of self-assertiveness in 2003 in Quaid-e-Azam University. The reliability is 0.70 that is satisfactory. This scale is used in present study. It is five point Likert type scale. Response category and scores are: Strongly agree = 5, Agree = 4, Cannot say = 3, Disagree = 2 and, Strongly disagree = 1. Items have reverse scoring i.e. 5, 10, 15, 16, 21, 22, and 27.

Validity of Measures: Inter-correlation among scores of these two scales i.e. BDI and Self-assertiveness for total sample have also been calculated to see the relationships between the measures of study.

RESULTS

Results presented in the table indicate that there is highly significant correlation between the two measures. The table 1 suggests that the correlation of Beck Depression Inventory (BDI) and Self-assertiveness (SA) is r = 0.73 (*** p< 0.0001). Our hypothesis regarding this relationship is supported which implies that depression is positively correlated with non-assertiveness.

Table 1: Correlation Matrix of Scores of Beck Depression Inventory (BDI) and Self-Assertiveness (SA) of both Genders (N=100)

***p<0.0001

Results in the table 2 show that there is insignificance of depression among two gender (t = 0.86, df = 98, p= n.s). This result suggests that it is not necessary that depression is more common among women. Both the gender (men and women) can experience same level of depression. The findings of this study do not support our hypothesis that women are more depressed than men.

Table 2: Means, Standard deviations, and t-value of the Scores of Men & Women on Beck Depression Inventory (N= 100)

df= 98, p= n.s.

Table 3 shows that there is significant difference in men and women regarding Self-Assertiveness (t = 2.21, df =98, **p< 0.01). The findings show that men are more assertive as compared to women. The result of this study supports our hypothesis.

Table 3: Means, Standard deviations and t- value of the scores of Men and Women on Self-Assertiveness Scale (N= 100)

df =98, **p< 0.01

Table 4 shows that there is significant difference in single and married people on Beck Depression Inventory (t = 3.11, df = 98, ***p<0.001). The findings further suggest that married people have more depressed feelings than unmarried people. Married people face more difficulties in their life and because of this they are more depressed than unmarried people.

Table 4: Means, Standard deviations and t- value of the scores of unmarried and married men and women on Beck Depression Inventory (N= 100)

df = 98, ***p<0.001

The findings of table 5 show that there is insignificant difference in assertiveness among married and unmarried people (t = 1.46, df = 98, p = n.s.). The results indicate that not only unmarried people are assertive, but married people can also show assertive behaviors. They also have the tendency of assertiveness. These findings reject our hypothesis.

Table 5: Means, Standard deviations and t- value of the Scores of married and unmarried people on Self-Assertiveness Scale (N = 100)

df = 98, p = n.s.

The results of table 6 show high significance of the scores of highly educated and low educated people on Beck Depression Inventory (t = 5.15, df = 98, ***p < 0.001). It indicates that highly educated people have to face less depression as compared to low educated people. This supports our hypothesis.

Table 6: Means, Standard deviations and t- value of the scores of highly educated and low educated people on Beck Depression Inventory (N=100)

df = 98, ***p < 0.001

The findings of table 7 show that there is significant difference among highly and low educated people on assertiveness scale (t = 2.97, df = 98, ***p< 0.001). This indicates that highly educated men and women are more Self-Assertive about their self as compared to low educated men and women. This finding of the study supports our hypothesis.

Table 7: Means, Standard deviations and t- value of the scores of high and low educated people on Self-Assertive Scale (N=100)

df = 98, ***p< 0.001

DISCUSSION

Present research was done to investigate the relationship of depression and assertiveness. Those who are depressed are usually non-assertive. The result shows that both the variables are positively correlated with each other. Findings also show that men are commonly more assertive in comparison with women. It also shows that married people are more depressed. Unmarried people are less depressed. Results also indicate that education plays significant part in depression and assertiveness.

The hypothesis pertaining to the relationship of depression and assertiveness is verified. It is supported by the results, which show that non-assertive people get depressed. Usually they do not recognize their own rights. And do not take stand for them. This type of behavior leads such people towards depression and this is all because of their wrong attitude towards life and their own self. So it becomes clear that those who are non-assertive eventually turn towards depression.

The second finding of the study does not support our hypothesis. According to the result there is no difference in the level of depression of men and women. This shows that depression strikes both genders equally. Although it seems men are less depressed this is because men are not very expressive. They do not share their feelings and their worries with other people. They do not express their inner self to any one. On the other hand women share almost each and every matter with their friends and family. They express their feelings without any hesitation so their depression is easily noticeable. So according to this result our hypothesis is not verified.

The third finding of this study verifies our hypothesis that men are more assertive than women. Men tend to be more assertive because they are considered to be having a strong and thoughtful personality. So our society not only accepts but also supports a man to be assertive. A research by Brouke [22] also showed same results. According to that research men are more assertive and women are more tender minded. So it becomes very clear that there is gender difference in self-assertiveness. Men are more assertive because of certain patterns of society. On the other hand our society does not give space to women to show their assertiveness.

The results of the hypothesis also show that married people are more depressed. It is usually because a married person has many responsibilities to fulfil. He/She has to do much effort to achieve his/her goals. Such people have worries about their future. Another important cause of depression among married people is marital dissatisfaction. A research also supports this finding. Usually married people suffer from depression because they are not satisfied with their spouses. A research by Jackson also supports this viewpoint. According to his study married people are usually depressed due to their marital dissatisfaction [23].

The result of the fifth table doesn’t support our hypothesis. According to the results unmarried people are not more assertive than married people. Married people tend to be more confident. They face life of their own without any support. On the other side unmarried people in our society live their lives under the shelter of their parents. In our society children are well protected by their parents. They do not face life of their own. That’s why they are not sufficiently assertive.

The next finding hypothesis is based on education level. According to the results highly educated people are less depressed than low educated people. Education opens one’s mind. An educated person does not see the limited aspects of some event or person. More over education gives awareness to the person that makes person’s life easy for his own self and for other people also. That is why educated people do not get depressed so easily. Depression is also prevalent in educated people but education makes a person confident on one’s self. So we can say that education reduces the incidence of depression in people.

The last finding of the result also supports the hypothesis that highly educated people are more assertive than low educated people. It is very clear that once a person learns, he becomes aware of one’s own self. He becomes aware of one’s own rights. Education makes a person confident. It is difficult to manipulate an educated person. So it is quite clear why an educated person is assertive.

CONCLUSION

The above discussion shows that self-assertiveness and depression are inter-related. Self-assertiveness is a positive trait that in benefit of every person. From the discussion it becomes very obvious that assertiveness leads a person towards a healthy personality without any complexes and regrets. It is also discussed that non-assertiveness leads a person to depression. A non-assertive person is never satisfied with his life that creates his life difficult for himself as well as for others. Men and women both are equal victim of depression. There is no gender difference in the incidence of depression.

Marriage plays important part in depression. Usually those people are depressed who are not satisfied with their marital life. They face problematic relationship with their spouse. Marital dissatisfaction leads a person towards depression very easily. Marital status is also important in self-assertiveness. A married person is usually self-assertive. Education is also very important in depression and self-assertiveness. Education improves one’s standard of living both economically and spiritually. It makes a person strong to face the world. This is also clear in the findings of our hypotheses.

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