The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms
ABSTRACT Adverse life events and social support may influence the outcome of major depressive disorder (MDD). We hypothesized that outcome would depend on the level of depressive symptoms present at the outset, with those in partial remission being particularly vulnerable.
In the Vantaa Depression Study (VDS), patients with DSM-IV MDD were interviewed at baseline, and at 6 and 18 months. Life events were investigated with the Interview for Recent Life Events (IRLE) and social support with the Interview Measure of Social Relationships (IMSR) and the Perceived Social Support Scale - Revised (PSSS-R). The patients were divided into three subgroups at 6 months, those in full remission (n = 68), partial remission (n = 75) or major depressive episode (MDE) (n = 50). The influence of social support and negative life events during the next 12 months on the level of depressive symptoms, measured by the Hamilton Rating Scale for Depression (HAMD), was investigated at endpoint.
The severity of life events and perceived social support influenced the outcome of depression overall, even after adjusting for baseline level of depression and neuroticism. In the full remission subgroup, both severity of life events and subjective social support significantly predicted outcome. However, in the partial remission group, only the severity of events, and in the MDE group, the level of social support were significant predictors.
Adverse life events and/or poor perceived social support influence the medium-term outcome of all psychiatric patients with MDD. These factors appear to have the strongest predictive value in the subgroup of patients currently in full remission.
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ABSTRACT: Recent neuroimaging studies support the contention that depression, pain distress, and rejection distress share the same neurobiological circuits. In two recently published studies we confirmed the hypothesis that the perception of increased pain during both treatment-refractory depression (predominantly unipolar) and difficult-to-treat bipolar depression was related to increased state rejection sensitivity (i.e., rejection sensitivity when depressed). In the present study, we aimed to compare the correlates of pain and rejection sensitivity in individuals with bipolar versus unipolar depression and test the hypothesis that bipolar disorder may be distinguished from unipolar depression both by an increased perception of pain and heightened rejection sensitivity during depression. We analyzed data from 113 bipolar and 146 unipolar depressed patients presenting to the Black Dog Institute, Sydney, Australia. The patients all met DSM-IV criteria for bipolar disorder or unipolar depression (major depressive disorder). Bipolar disorder predicted a major increase in state rejection sensitivity when depressed (p = 0.001), whereas trait rejection sensitivity (i.e., a long-standing pattern of rejection sensitivity) was not predicted by polarity. A major increase in the experience of headaches (p = 0.007), chest pain (p < 0.001), and body aches and pains (p = 0.02) during depression was predicted by a major increase in state rejection sensitivity for both bipolar and unipolar depression. State, but not trait, rejection sensitivity is significantly predicted by bipolar depression, suggesting that this might be considered as a state marker for bipolar depression and taken into account in the clinical differentiation of bipolar and unipolar depression.Bipolar Disorders 03/2014; 16:190-198. DOI:10.1111/bdi.12147 · 4.89 Impact Factor
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ABSTRACT: Objective: This study examined predictors of persistent major depressive disorder (MDD) over 10 years, focusing on the effects of clinical variables, physical health, and social support. Method: The National Survey of Midlife Development in the United States (MIDUS) in 1995-1996 and the follow-up in 2004-2006 were analyzed. Respondents were non-institutionalized English-speaking adults. Individuals who met clinical-based criteria for Major Depressive Disorder (MDD) at Time 1 were included in the analysis. Logistic regression was used with the baseline variables to predict non-recovery from MDD at follow-up. Results: Fifteen percent of the total sample was classified as having MDD in 1995-1996. Of those with MDD at baseline, 37% were also classified as having MDD in 2004-2006. Baseline variables that were associated with persistent MDD at follow-up were being female (OR=2.51; 95% CI: 1.28-4.92), having a comorbid anxiety disorder (OR=5.79; CI:2.29-14.62), having two or more chronic medical conditions (OR=2.61; 95% CI: 1.16-5.89), experiencing activity limitation (OR=2.45; CI: 1.96-4.41), and less contact with family (OR=2.41; CI: 1.40-4.27). Conclusion: A significant proportion of individuals experience persistent MDD after 10 years. Treatment strategies focused on physical health, social, and mental health needs are necessary to comprehensively address the factors that contribute to persistent MDD.140st APHA Annual Meeting and Exposition 2012; 10/2012
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ABSTRACT: Adolescence is a peak period for the onset of depression, and it is also a time marked by substantial stress as well as neural development within the brain reward circuitry. In this review, we provide a selective overview of current animal and human research investigating the relationship among reward processes, stress, and depression. Three separate, but related, etiological models examine the differential roles that stress may play in relation to reward dysfunction and adolescent depression. First, the reward mediation model suggests that both acute and chronic stress contribute to reward deficits, which, in turn, potentiate depressive symptoms or increase the risk for depression. Second, in line with the stress generation perspective, it is plausible that premorbid reward-related dysfunction generates stress-in particular, interpersonal stress-which then leads to the manifestation of depressive symptoms. Third, consistent with a diathesis-stress model, the interaction between stress and premorbid reward dysfunction may contribute to the onset of depression. Given the equifinal nature of depression, these models could shed important light on different etiological pathways during adolescence, particularly as they may relate to understanding the heterogeneity of depression. To highlight the translational potential of these insights, a hypothetical case study is provided as a means of demonstrating the importance of targeting reward dysfunction in both assessment and treatment of adolescent depression.Harvard Review of Psychiatry 04/2014; DOI:10.1097/HRP.0000000000000034 · 2.49 Impact Factor