The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms

Faculty of Behavioural Sciences, University of Helsinki, Helsinki, Uusimaa, Finland
Psychological Medicine (Impact Factor: 5.94). 07/2006; 36(6):779-88. DOI: 10.1017/S0033291706007276
Source: PubMed


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.

17 Reads
    • "In previous studies, severity and duration of the disorder as well as comorbidity have been identified as risk factors of an unfavourable course of illness, but there are mixed findings on sociodemographic factors, such as sex and age (Eaton et al., 2008, Holma et al., 2008, Spijker et al., 2001). Childhood adversity, low social support and adverse life events have been associated with worse prognosis (Gilman et al., 2013, Leskelä et al., 2006, Rhebergen et al., 2011). Further, prognosis extends beyond presence or absence of diagnosis; information on residual symptoms, quality of life and mortality is also important. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Depressive disorders are among the most pressing public health challenges worldwide. Yet, not enough is known about their long-term outcomes. This study examines the course and predictors of different outcomes of depressive disorders in an eleven-year follow-up of a general population sample. Methods: In a nationally representative sample of Finns aged 30 and over (BRIF8901), major depressive disorder (MDD) and dysthymia were diagnosed with the Composite International Diagnostic Interview (M-CIDI) in 2000. The participants were followed up in 2011 (n=5733). Outcome measures were diagnostic status, mortality, depressive symptoms and health-related quality of life. Multiple imputation (MI) was used to account for nonresponse. Results: At follow-up, 33.8% of persons with baseline MDD and 42.6% with baseline dysthymia received a diagnosis of depressive, anxiety or alcohol use disorder. Baseline severity of disorder, measured by the Beck Depression Inventory, predicted both persistence of depressive disorder and increased mortality risk. In addition, being never-married, separated or widowed predicted persistence of depressive disorders, whereas somatic and psychiatric comorbidity, childhood adversities and lower social capital did not. Those who received no psychiatric diagnosis at follow-up still had residual symptoms and lower quality of life. Limitations: We only had one follow-up point at eleven years, and did not collect information on the subjects' health during the follow-up period. Conclusions: Depressive disorders in the general population are associated with multiple negative outcomes. Severity of index episode is the strongest predictor of negative outcomes. More emphasis should be placed on addressing the long-term consequences of depression.
    No preview · Article · Nov 2015 · Journal of Affective Disorders
  • Source
    • "They would simply indicate vulnerability to depression. Some longitudinal studies also found that the severity of life events [28] influences the outcomes of depression. Some other studies have identified the number of daily hassles as potential risk factors for persistence [29] while other studies did not find any association [30] or in the multivariate model this effect disappeared [31]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to describe changes in depression and its correlates, in community-dwelling elderly, over a 12-month period. Data come from a longitudinal ESA Study (Enquête sur la Santé des Aînés) of elderly persons (n = 2752). Depression was measured using the DSM-IV criteria. Polytomous logistic regression was used to assess relations, over time, between participant's characteristics and depression. Among the 164 (5.9%) subjects, who were depressed at baseline, 19.5% were continuously ill cases and 80.4% had recovered, 12 months later. In polytomous regression, factors increasing the probability of the three depression states (persistence, recovery, and incidence) were daily hassles, stress intensity, and fair/poor self-rated mental health. Depression in old age is dynamic. Available prognostic factors can be taken into account to help direct treatment to elderly at highest risk of a poor prognosis.
    Full-text · Article · Mar 2013 · Depression research and treatment
    • "In a systematic review of depression studies in primary care, Gilchrist and Gunn (2007) found that risk factors for persistent depression were suicidal thoughts, severity and chronicity of symptoms, low quality of life, less education, and unemployment. Conversely, better depression outcomes are associated with greater social support (Ezquiaga et al. 2004; Gilchrist and Gunn 2007; Leskela et al. 2006; Nasser and Overholser 2005; Szadoczky et al. 2004; Zlotnick et al. 1996), being married (Meyers et al. 2002; Mueller et al. 1996), receiving adequate antidepressant treatment (Meyers et al. 2002), and experiencing fewer stressful life events (Leskela et al. 2006; Zlotnick et al. 1996). These clinic-based studies provide an overview of the multiple variables that influence the course of depressive symptoms. "
    [Show abstract] [Hide abstract]
    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.
    No preview · Conference Paper · Oct 2012
Show more