Predicting recurrence of major depressive disorder in young adults: a prospective study

Psychosocial adjustment of U.S. college students in the early months of the COVID-19 pandemic

Objective: Examine the psychosocial adjustment of U.S. college and university students during the early months of the COVID-19 pandemic. Participants: Higher education students in the U.S. (N = 228), recruited between March 2020 and May 2020. Methods: Participants completed self-report measures regarding their psychosocial functioning online. Qualitative and quantitative methods were used to explore participants' psychosocial adjustment. Results: Participants reported increased concerns about such stressors as academics, job loss, health, and social isolation. They reported significantly elevated symptoms of depression, anxiety, perceived stress, and somatization, and prior history of psychological counseling was associated with greater levels of distress. Approximately one-third of participants reported inadequate perceived social support, which in turn was linked to psychosocial adjustment. Conclusions: College students reported experiencing a wide range of stressors related to the pandemic. Increasing access to mental health services and providing supportive services in such areas as social connection and employment are encouraged.

Correlates of suicidality in young people with depressive disorders: A systematic review

OBJECTIVE

Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders.

METHOD

Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15-25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines.

RESULTS

We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible.

CONCLUSION

Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.

Family Interaction and Depressive Symptoms in Chinese Emerging Adults: A Mediation Model of Gratitude

In this study, we investigated the relations between family interaction, gratitude, and depressive symptoms among Chinese emerging adults. It also investigated gratitude as a mediator in the relation between family interaction and depression. Data were obtained from 321 college students who completed the online questionnaire about the Family Assessment Instrument, Gratitude Questionnaire, Patient Health Questionnaire, and demographic information. Structural equation modeling (SEM) was used to test hypotheses and bootstrapping with 5,000 resamplings (95% confidence interval) was used to confirm the mediation model. Results showed that gratitude partially mediated the relation between family interaction and depression. In other words, students with healthy family interaction, as indicated by perceived better family communication, mutuality, and harmony with family members, tended to report higher general gratitude, and subsequently diminished depressive symptoms. The practical implications were discussed.

Self-rated residual symptoms do not predict 1-year recurrence of depression

Background

Residual depressive symptoms are generally documented as a risk factor for recurrence. In the absence of a specific instrument for the assessment of residual symptoms, a new 25-item Depression Residual Symptom Scale (DRSS) was elaborated and tested for recurrence prediction over a 1-year follow-up.

Sampling and methods

Fifty-nine patients in remission after a major depressive episode (MDE) were recruited in two centres. They were assessed with the DRSS and the Montgomery-Asberg Depression Rating Scale (MADRS) at inclusion and followed for 1 year according to a seminaturalistic design. The DRSS included specific depressive symptoms and subjective symptoms of vulnerability, lack of return to usual self and premorbid level of functioning.

Results

Severity of residual symptoms was not significantly associated with increased risk of recurrence. However, DRSS score was significantly higher among patients with three or more episodes than one to two episodes. Number of previous episodes and treatment interruption were not identified as significant predictors of recurrence.

Conclusion

The proposed instrument is not predictive of depressive recurrence, but is sensitive to increased perception of vulnerability associated with consecutive episodes. Limitations include small sample size, seminaturalistic design (no standardisation of treatment) and content of the instrument.

Neurocognitive performance predicts treatment outcome with cognitive behavioral therapy for major depressive disorder

The current study examined the contribution of baseline neuropsychological functioning to the prediction of antidepressant outcome with cognitive behavioral therapy (CBT) for Major Depressive Disorder (MDD). We hypothesized that depressed participants who were more neurocognitively intact and had less rigid, negative thinking would respond better to CBT. Thirty-one MDD patients completed a comprehensive neuropsychological battery before initiation of CBT. A subgroup also completed a probabilistic reversal learning task. Depression severity was assessed with the Beck Depression Inventory (BDI); rigid, negative thinking was assessed with the Dysfunctional Attitudes Scale (DAS) and the Automatic Thoughts Questionnaire (ATQ) throughout treatment. Remitters were compared to non-remitters. Paradoxically, eventual remitters performed generally worse across the neuropsychological battery considered as a whole. Univariate testing showed a significant difference on only a single measure, the Continuous Performance Test d', when corrected for multiple comparisons. Baseline rigid, negative thinking did not predict treatment outcome. Results suggest that the structure of CBT may particularly benefit individuals with mild depression-related neurocognitive difficulties during a depressive episode. Further research is needed to examine these patient characteristics and their potential contribution to the mechanisms of CBT efficacy.

Understanding Sociobehavioral Mitigators of Depressive Symptoms among U.S. Young Adults

This study drew upon an ecological system framework to examine a model focusing on the interrelationship among depressive symptoms, sense of mastery, moderate-to-vigorous physical activity (MVPA), religiosity, and relations with parents and romantic partners among U.S. young adults aged 24 to 34. Cross-sectional data from the National Longitudinal Study of Adolescent Health (N = 4,982), obtained in 2008 and 2009, were analyzed using structural equation modeling techniques. The associations of MVPA, relations with parents, and relations with romantic partner to depressive symptoms were mediated through mastery. Relations with one's romantic partner were a stronger predictor of depressive symptoms than relations with parents, while the influence of religiosity on relations with romantic partner was largely mediated by relations with parents. The results highlight the sociobehavioral buffers of depressive symptoms that are peculiar to young adulthood. Further intervention research in preventing and treating depressive symptoms should consider incorporating the sociobehavioral factors that are tailored to the specific age group.

Dysfunctional Attitudes and Affective Responses to Daily Stressors: Separating Cognitive, Genetic, and Clinical Influences on Stress Reactivity

Despite decades of research examining diathesis-stress models of emotional disorders, it remains unclear whether dysfunctional attitudes interact with stressful experiences to shape affect on a daily basis and, if so, how clinical and genetic factors influence these associations. To address these issues, we conducted a multi-level daily diary study that examined how dysfunctional attitudes and stressful events relate to daily fluctuations in negative and positive affect in 104 young adults. Given evidence that clinical and genetic factors underlie stress sensitivity, we also examined how daily affect is influenced by internalizing and externalizing symptoms and brain-derived neurotrophic factor (BDNF) genotype, which have been shown to influence neural, endocrine, and affective responses to stress. In multivariate models, internalizing symptoms and BDNF Val66Met genotype independently predicted heightened negative affect on stressful days, but dysfunctional attitudes did not. Specifically, the BDNF Met allele and elevated baseline internalizing symptomatology predicted greater increases in negative affect in stressful circumstances. These data are the first to demonstrate that BDNF genotype and stress are jointly associated with daily fluctuations in negative affect, and they challenge the assumption that maladaptive beliefs play a strong independent role in determining affective responses to everyday stressors. The results may thus inform the development of new multi-level theories of psychopathology and guide future research on predictors of affective lability.

Comparing chronic interpersonal and noninterpersonal stress domains as predictors of depression recurrence in emerging adults

Understanding how persistent interpersonal difficulties distinctly affect the course of major depressive disorder (MDD) during emerging adulthood is critical, given that early experiences impact future coping resources and functioning. Research on stress and MDD has mostly concentrated on stressful life events, while chronic stress largely has not been explored. The present study examined interpersonal (intimate relationship, close friendships, social life, family relationships) and noninterpersonal (academic, work, financial, personal health, and family members' health) domains of chronic stress as time-varying predictors of depressive recurrence in emerging adults. Baseline assessments identified previously depressed emerging adults (N = 119), who subsequently completed 6-month, 12-month and 18-month follow-up interviews to determine chronic stress experiences and onset of new major depressive episodes. Survival analyses indicated that time-varying total chronic stress and chronic interpersonal stress predicted higher risk for depression recurrence; however, chronic noninterpersonal stress was not associated with recurrence. Intimate relationship stress, close friendship stress, family relationship stress, personal health, and family members' health independently predicted MDD recurrence, over and above well-established depression risk factors of dysfunctional cognitions and personality disorder symptoms. Evidence that interpersonal stress could have substantial impact on course of depression is consistent with theories of emerging adulthood, a time when young people are individuating from the family and experiencing significant social transition.

Personality Disorder Traits as a Moderator of Poor Social Problem-Solving Skills and Depressive Symptoms

This investigation examined whether Cluster B and Cluster C personality disorder symptoms moderate the relationship between social problem-solving skills and depressive symptoms. Participants were 102 young adults, assessed for personality disorder traits and depressive symptoms. Participants completed a novel performance-based assessment and a self-report measure of social problem-solving skills. Multiple regression models indicated that at moderate to lower levels of personality pathology, social problem-solving deficits were associated with depressive symptoms, whereas at higher levels of personality pathology there was not a similar relationship. These findings highlight the importance of both social problem-solving approaches and personality characteristics in understanding the complex network of risk factors for depression.

Sex differences in clinical predictors of depression: a prospective study

BACKGROUND

Estimating the likelihood of future major depressive episodes (MDEs) would assist clinicians in decision-making regarding the optimal length of treatment for MDE. Unfortunately, little data are available to guide clinical practice.

METHODS

We followed 200 females and 152 males who responded to treatment for a MDE for 2 years to determine risk factors for future MDE. Cox Proportional Hazard Regression modeled time to first relapse into MDE and mixed effect logistic regression modeled monthly depression status.

RESULTS

Females were more likely than males to experience a MDE in any month of the study, and marginally more likely to experience a relapse. By 12 months, 60% of females had relapsed compared to 51% of males (median time to relapse 8 vs. 13 months, respectively). Several factors predicted worse outcome for both men and women: reported childhood abuse, earlier age of onset of first MDE, bipolar disorder, unemployment, and more years of education. For females, but not males, suicidal ideation predicted MDE relapse and both suicidal ideation and prior suicide attempts were associated with more time in a MDE.

LIMITATIONS

The naturalistic treatment of participants, exclusion of individuals with current comorbid alcohol or substance use disorder, and a follow up period of two years are limitations.

CONCLUSIONS

Women are more vulnerable to relapse and spend more time depressed compared to men. Identification of general and sex-specific risk factors for future depression may provide clinicians with useful tools to estimate need for ongoing pharmacotherapy in MDE.

Prevention of recurrence of major depression among emerging adults by a group cognitive-behavioral/interpersonal intervention

BACKGROUND

Among the most serious sequelae to an initial episode of Major Depressive Disorder (MDD) during adolescence is the significant increase in the probability of recurrence. This study reports on an integrated CBT/IPT program, provided in a group format, that was developed to decrease the rate of MDD recurrence in emerging adults.

METHODS

Participants were 89 young adults who were not depressed at study entry but had experienced MDD during adolescence. Participants were assigned to a CBT/IPT prevention program or to an assessment only control condition and were followed through the first 2 years of college.

RESULTS

Risk for MDD recurrence was reduced more than 50% for the prevention program participants compared to assessment only controls. The intervention also conferred beneficial effects on academic performance for those students who completed the majority of the group sessions.

LIMITATIONS

The study included a self-selected sample of emerging adults who were aware of their history of depression. Due to the small sample size, it will be important to evaluate similar interventions in adequately-powered trials to determine if this is a replicable finding.

CONCLUSIONS

With 51% of the assessment only participants experiencing a MDD recurrence during the first 2 years of college, these findings support the need for programs designed to prevent MDD recurrence in young adults. The current program, based on IPT and CBT principles, appears to reduce the rate of MDD recurrence among previously depressed emerging adults.

Personality disorders predict relapse after remission from an episode of major depressive disorder: a 6-year prospective study

OBJECTIVE

To examine prospectively the course of major depressive disorder (MDD) and to test for the moderating effects of personality disorder (PD) comorbidity on relapse after remission from an episode of MDD.

METHOD

Participants were 303 patients (196 women and 107 men) with current DSM-IV-diagnosed MDD at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study. Major depressive disorder and Axis I psychiatric disorders were assessed with the Structured Clinical Interview for DSM-IV, and Axis II PDs were assessed with the Diagnostic Interview for DSM-IV Personality Disorders. The course of MDD was assessed with the Longitudinal Interval Follow-up Evaluation at 6 and 12 months and then yearly through 6 years. Survival analyses were used to analyze time to remission and time to relapse. The study was conducted from July 1996 to June 2005.

RESULTS

Of 303 patients, 260 (86%) remitted from MDD; life table survival analyses revealed that patients with MDD who had PDs at baseline had significantly longer time to remission from MDD than patients without PDs. Among the 260 patients whose MDD remitted, 183 (70%) relapsed. Patients with MDD with PDs-specifically those with borderline and obsessive-compulsive PDs-at baseline had significantly shorter time to relapse than patients with MDD without PDs. Cox proportional hazards regression analyses revealed that the presence of PDs at baseline (hazard ratio = 1.5) and recurrent-type MDD (hazard ratio = 2.2), but not sex (hazard ratio = 1.03) or dysthymic disorder (hazard ratio = 0.97), significantly predicted time to relapse.

CONCLUSIONS

Personality disorders at baseline were robust predictors prospectively of accelerated relapse after remission from an episode of MDD. Personality disorders at baseline significantly moderated eventual time to relapse in MDD among patients who remitted from an episode of MDD, even when controlling for other potential negative prognostic predictors.

An evaluation of an integrated model of relapse in depression

BACKGROUND AND AIM

The present study evaluated an integrated model of the role of psychosocial factors in the prediction of relapse of Major Depressive Disorder over a one-year follow-up period.

METHODS AND ANALYSES

A range of established variables, including life stress, cognitive-personality vulnerability factors, social support, and coping responses, were simultaneously considered in a series of prediction models, in an adult female sample of remitted depressed individuals.

RESULTS

It was determined that interpersonal marked difficulties, social support, and emotion-oriented and avoidance-oriented coping provided the best-fitting and most parsimonious predictive model for depressive relapse at one-year follow-up.

CONCLUSIONS

The examination of multifactorial models of risk represents a promising avenue for future research and theory development.

The long-term effects of mindfulness-based cognitive therapy as a relapse prevention treatment for major depressive disorder

BACKGROUND

Mindfulness-based Cognitive Therapy (MBCT) is a relapse prevention treatment for major depressive disorder.

METHOD

An observational clinical audit of 39 participants explored the long-term effects of MBCT using standardized measures of depression (BDI-II), rumination (RSS), and mindfulness (MAAS).

RESULTS

MBCT was associated with statistically significant reductions in depression from pre to post treatment. Gains were maintained over time (Group 1, 1-12 months, p = .002; Group 2, 13-24 months, p = .001; Group 3, 25-34 months, p = .04). Depression scores in Group 3 did begin to worsen, yet were still within the mild range of the BDI-II. Treatment variables such as attendance at "booster" sessions and ongoing mindfulness practice correlated with better depression outcomes (p = .003 and p = .03 respectively). There was a strong negative correlation between rumination and mindful attention (p < .001), consistent with a proposed mechanism of metacognition in the efficacy of MBCT.

CONCLUSION

It is suggested that ongoing MBCT skills and practice may be important for relapse prevention over the longer term. Larger randomized studies of the mechanisms of MBCT with longer follow-up periods are recommended.

Characteristics, correlates, and outcomes of childhood and adolescent depressive disorders

Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, understanding the disorder during this developmental stage is critical for determining its etiology and course, as well as for deveiopinq effective intervention straieqies. This paper summarizes current knoviedqe reqardinq the etiology, phenomenoiogy, correlates, natural course, and consequences of unipolar depression in children and adolescents. Using adult depression as a framevork, the unique aspects of childhood and adolescence are considered in order to better understand depression within a developmental context. The data suggest that the clinical presentation, correlates, and natural course of depression are remarkably similar across the lifespan. There are, however, important developmental differences. Specifically, the familial and psychological context in which depression develops in youngsters is associated with variability in the frequency and nature of depressive symptoms and comorbid conditions among children and adolescents. Maturational differences have also been identified in the neurobiological correlates of depression. These developmental differences may be associated with the observed variability in clinical response to treatment and longitudinal course. Characterization of the developmental differences will be helpful in developing more specific and effective interventions for youngsters, thereby allowing them to reach their full potential as adults.

Do major depressive disorder and dysthymic disorder confer differential risk for suicide?

BACKGROUND

Although there has been a tremendous amount of research examining the risk conferred for suicide by depression in general, relatively little research examines the risk conferred by specific forms of depressive illness (e.g., dysthymic disorder, single episode versus recurrent major depressive disorder [MDD]). The purpose of the current study was to examine differences in suicidal ideation, clinician-rated suicide risk, suicide attempts, and family history of suicide in a sample of outpatients diagnosed with various forms of depressive illness.

METHODS

To accomplish this aim, we conducted a cluster analysis using the aforementioned suicide-related variables in a sample of 494 outpatients seen between January 2001 and July 2007 at the Florida State University Psychology Clinic. Patients were diagnosed using DSM-IV criteria.

RESULTS

Two distinct clusters emerged that were indicative of lower and higher risk for suicide. After controlling for the number of comorbid Axis I and Axis II diagnoses, the only depressive illness that significantly predicted cluster membership was recurrent MDD, which tripled an individual's likelihood of being assigned to the higher risk cluster.

LIMITATIONS

The use of a cross-sectional design; the relatively low suicide risk in our sample; the relatively small number of individuals with double depression.

CONCLUSIONS

Our results demonstrate the importance of both chronicity and severity of depression in terms of predicting increased suicide risk. Among the various forms of depressive illness examined, only recurrent MDD appeared to confer greater risk for suicide.

Prevention of depression among Icelandic adolescents

Major depression and dysthymia are frequent, debilitating, and chronic disorders, whose highest rate of initial onset is during the late adolescent years. The effectiveness of a program designed to prevent an initial episode of major depression or dysthymia among adolescents was investigated. Participants were 171 fourteen-year-old "at risk" Icelandic adolescents who were randomly assigned to a prevention program or a treatment-as-usual assessment only control group. They were identified as "at risk" by reporting the presence of depressive symptoms or a negative attributional style. The program was based on a developmental psychosocial model of enhancement of resilience to factors associated with the occurrence of mood disorders. The results indicated that the prevention program resulted in a significantly lower rate of major depression and dysthymia than did the control group. The study demonstrated that school personnel in the school setting can implement such prevention programs.

Hope in psychiatry: a review of the literature

OBJECTIVE

Hope has long been considered an important therapeutic factor in medicine, nursing and mental health and recently received attention as a central component of recovery. However, conceptual clarity, applicability and the predictive value of hope remain unclear. This review aims to define hope, review current approaches to assessment, and outline research evidence linking hope with effectiveness.

METHOD

We conducted a comprehensive review of publications on the conceptualisation and measurement of hope, and on its use as a predictive variable specifically in mental health patients.

RESULTS

Forty-nine definitions of hope were identified, which were grouped into seven emergent dimensions. Thirty-two measurement tools were identified, although few have been used in research involving mental health patients. Eleven studies investigated hope as a predictive variable for differing outcomes, with inconclusive results.

CONCLUSION

Many conceptual frameworks for hope have been proposed, but empirical evidence on its predictive power in mental health is lacking.

Personality disorders and perceived stress in major depressive disorder

The investigation of comorbidity between major depressive disorder (MDD) and personality disorders (PDs) has attracted considerable interest. Whereas some studies found that the presence of PDs has adverse effects on the course and treatment of MDD, others have failed to demonstrate this link. These inconsistent findings suggest that specific PD comorbidity might affect the course of MDD by modulating factors that increase the overall risk of depression, including an elevated tendency to perceive stress. To investigate whether the presence of a specific PD cluster was associated with elevated levels of stress appraisal, we administered the Perceived Stress Scale (PSS) before and after treatment to 227 MDD outpatients enrolled in an 8-week open-label treatment with fluoxetine. Following treatment, multiple linear regression analyses revealed that the presence of Cluster A, but not Cluster B or C, was associated with higher levels of perceived stress, even after adjusting for baseline depression severity and PSS scores, as well as various sociodemographic variables. The presence of Cluster A PD comorbidity was uniquely associated with elevated stress appraisal after antidepressant treatment, raising the possibility that stress exacerbation might be an important factor linked to poor treatment outcome in MDD subjects with Cluster A pathology.

Perceived stress and cognitive vulnerability mediate the effects of personality disorder comorbidity on treatment outcome in major depressive disorder: a path analysis study

Although personality disorder (PD) comorbidity has been associated with poor treatment outcome in major depressive disorder (MDD), little is known about mechanisms mediating this link. Converging evidence suggests that maladaptive cognitive patterns, particularly in interaction with stressors, might lead to poor treatment outcome in MDD subjects with PD pathology. The goal of this study was to test the role of PD comorbidity, cognitive vulnerability, and perceived stress in treatment outcome in MDD. Three hundred eighty-four MDD outpatients were enrolled in an 8-week open-label treatment of fluoxetine. Structural equation modeling and path analyses revealed that the effect of PD vulnerability on treatment outcome was fully mediated by increased pretreatment cognitive vulnerability and depression severity, which led to increased stress perception after treatment and poorer antidepressant response. Depressogenic cognitions might be continuously activated by chronic distress in MDD subjects reporting axis II pathology, leading to stress exacerbation and eventually poorer treatment outcome.

Effects of personality disorders on functioning and well-being in major depressive disorder

BACKGROUND

Patients with depressive disorders have limitations in physical and emotional functioning comparable to patients with chronic medical conditions. Personality disorders (PDs) are also known to be associated with functional impairment.

AIMS

To determine the effects of PDs on the functioning and well-being of patients with major depressive disorder (MDD).

METHOD

In the Collaborative Longitudinal Personality Disorders Study, 668 patients who met criteria for schizotypal, borderline, avoidant, or obsessive-compulsive PDs or for MDD and no PD were assessed with semi-structured interviews at baseline, 6, 12, 24, and 36 months. In this study, 151 patients who met criteria for current MDD at the 36-month follow-up were compared on the basis of the presence (n = 118) or absence (n = 33) of persistent PD. Physical and social/emotional functioning and well-being were assessed using the Medical Outcomes Study (MOS) Short-Form Health Survey (SF-36). These results were compared with those of a sample of patients with MDD seen in the mental health specialty sector who were followed in the Medical Outcomes Study.

RESULTS

Patients with MDD and co-occurring PD had significantly more impairment on scales measuring role limitations due to emotional problems, social functioning, and general health perceptions than patients with MDD and no PD. Although patients with MDD and no PD were found to have levels of functioning and well-being that were lower in several domains than those previously reported in depressed patients recruited from mental health settings, patients with MDD and co-occurring PD were found to have much lower levels of functioning in all areas than reported samples.

CONCLUSIONS

Co-occurring PDs contribute significantly to impairment in social and emotional functioning and reduced well-being in patients with MDD.

A history of major depressive disorder and the response to stress

BACKGROUND

The occurrence of Major Depressive Disorder (MDD) has been linked to an increased vulnerability to stress. However, the specific behavioral and affective aspects that may underlie this vulnerability to stress have not been well studied.

METHODS

This study examined sensitivity to a stress manipulation in 62 participants, 30 with and 32 without a previous episode of MDD. Comparisons were made between those with a history of depression and those without, randomized to either the high or low stress conditions on self-report measures of affect and behavior measures of performance.

RESULTS

A significant interaction was found between depression history and level of stress on measures of self-report tension and behavioral performance on the experimental task. Specifically, those with a history of MDD in the high stress condition reported significantly more tension than other participants. Additionally, participants in the high stress condition without a history of MDD responded to uncontrollable stress by responding at a significantly higher rate on the task while those individuals with a history of MDD responded to uncontrollable stress by maintaining a relatively low level of responding. No differences in self-report depressed affect were found.

LIMITATIONS

The study utilized a laboratory stressor in a sample composed primarily of college students.

CONCLUSIONS

A history of MDD appears to be associated with an increased sensitivity to uncontrollable stress. This vulnerability may manifest itself in the subjective state of individuals (i.e., tension) or in their behavioral responses to stress.

A closer look at treatment resistant depression: is it due to a bipolar diathesis?

BACKGROUND

Treatment resistant depression is a common clinical problem. Studies have shown that a large number of patients with depression do not have a satisfactory clinical outcome in spite of adequate trials of antidepressant drugs. In this study, we investigated demographic and clinical characteristics, diagnostic subtypes, and illness outcome of patients with resistant depression and a history of escape of response to adequate trials of at least two antidepressants for a previous episode.

METHOD

Sixty-one patients who were seen consecutively at a mood disorders clinic with the diagnosis of "unipolar" treatment resistant depression, and followed up for at least one year, were interviewed using the Structured Clinical Interview for DSM-IV. Prospectively collected data including the occurrence of episodes of hypomania, and supplemental information from family members on illness course were also used for purposes of diagnostic re-evaluation.

RESULTS

At intake, 35% of the patients were diagnosed as having a bipolar disorder. At follow-up, there was a 59% prevalence of bipolar disorder. Of the patients with major depressive disorder, 52% were subsequently classified as having bipolar spectrum disorder. The most important finding was that 80% of patients were found to show evidence of bipolarity. Moreover, the most common change in medication was a switch to mood stabilizers. CGI ratings showed significant improvement in functioning from the time of initial consultation.

LIMITATIONS

This was a naturalistic study, and the data were collected in a non-blind fashion.

CONCLUSIONS

The findings suggest that the majority of cases of unipolar treatment resistant depression, occurring in the context of loss of antidepressant response, have a bipolar diathesis.

Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity

In this study, the authors examined prospectively the 24-month natural course of remission from major depressive disorder (MDD) as a function of personality disorder (PD) comorbidity. In 302 participants (196 women, 106 men), psychiatric and PDs were assessed at baseline with diagnostic interviews, and the course of MDD was assessed with the Longitudinal Interval Follow-Up Evaluation at 6-, 12-, and 24-month follow-ups. Survival analyses revealed an overall 24-month remission rate of 73.5% for MDD that differed little by gender. Participants with MDD who had certain forms of coexisting PD psychopathology (schizotypal, borderline, or avoidant) as their primary PD diagnoses had a significantly longer time to remission from MDD than did patients with MDD without any PD. These PDs emerged as robust predictors of slowed remission from MDD even when controlling for other negative prognostic predictors.

Expressed emotion versus relationship quality variables in the prediction of recurrence in bipolar patients

BACKGROUND

The expressed emotion (EE) construct has predicted clinical outcomes in schizophrenia and depression, but few studies have been conducted with bipolar patients. Moreover, there is a particular dearth of information regarding the prediction of depressive versus manic episodes in bipolar patients. Questions also remain about the utility of EE compared to other variables (perceived criticism, relationship negativity, and chronic strain in close relationships) that more directly evaluate interpersonal stress and about specific predictions of mania or depression.

METHODS

Forty-seven outpatients with bipolar I disorder participated in a 1-year longitudinal study. A close collateral of the patient completed the Five Minute Speech Sample (FMSS) to assess EE, and participants completed perceived criticism and negativity ratings of collaterals. Clinical outcomes and chronic interpersonal stress were assessed by interview at 3-month intervals.

RESULTS

High EE predicted depressive, but not manic recurrence. Other variables of close interpersonal relationships were not significant predictors of recurrence.

LIMITATIONS

Participants nominated collaterals, and those who did not have such a confidant were excluded.

CONCLUSIONS

The FMSS was sensitive to even mild negativity by the collateral that predicted later depressive episodes. This is the first study to demonstrate polarity-specific effects of EE on the prediction of recurrence in bipolar disorder.

Cognitive predictors of symptom return following depression treatment

This study tested whether poor cognitive change during depression treatment predicted time to return of depressive symptoms. Depressed participants (N = 121) completed assessments of dysfunctional attitudes and extreme thinking (i.e., number of totally agree and totally disagree responses) during hospitalization and again after 6 months of outpatient treatment. Participants then completed monthly depression assessments for 1 year. Survival analyses for time to symptom recurrence during follow-up were conducted among participants who reported 50% improvement in their depressive symptoms and were at least partially asymptomatic at the end of treatment (n = 53). Poor change in dysfunctional attitudes and poor change in extreme thinking both predicted shorter time to return of depressive symptoms.

Patients' versus informants' reports of personality disorders in predicting 7 1/2-year outcome in outpatients with depressive disorders

Concordance between patients' and informants' reports of personality disorders (PDs) is low, raising the questions of which source provides more valid data and whether both contribute unique information. This study compared patients' and informants' reports of PDs in predicting outcome in a 7 1/2-year follow-up of 85 depressed outpatients. Patients and informants were independently evaluated using structured interviews; outcome was assessed using structured interviews with patients. Both patients' and informants' reports of PD diagnoses and dimensional scores independently predicted depression symptoms and global functioning at follow-up. However, only informants' reports made a unique contribution to predicting social adjustment. This finding indicates that both patients and informants provide unique information on Axis II psychopathology and argues for the use of both sources in the assessment of PDs.