Risk for recurrence in depression

Abstract

Depression is a highly recurrent disorder with significant personal and public health consequences. Prevention of recurrence would be extremely desirable, and thus researchers have begun to identify risk factors that are specific to recurrence, which may be different from risk factors for first-onset of depression. Methodological issues in this area of research are briefly reviewed (e.g., the various definitions of "recurrence" and "depression"), followed by a review of studies on specific risk factors, including demographic variables (gender, socio-economic status, marital status), clinical variables (age at first onset, number of prior episodes, severity of first/index episode, comorbid psychopathology), family history of psychopathology, and psychosocial and psychological variables (level of psychosocial functioning, cognitions, personality, social support, and stressful life events). In addition, scar theories are evaluated for their potential to explain how these variables and recurrent depression are linked. Our review suggests that recurrent depression reflects an underlying vulnerability that is largely genetic in nature and that may predispose those high in the vulnerability not only to recurrent depressive episodes, but also to the significant psychosocial risk factors that often accompany recurrent depression.Major depressive disorder is one of the most common forms of psychopathology, one that will affect approximately one in six men and one in four women in their lifetimes . It is also usually highly recurrent, with at least 50% of those who recover from a first episode of depression having one or more additional episodes in their lifetime, and approximately 80% of those with a history of two episodes having another recurrence (American Psychiatric Association, 2000;Kupfer, Frank, & Wamhoff, 1996;Post, 1992). Once a first episode has occurred, recurrent episodes will usually begin within five years of the initial episode (Belsher & Costello, 1988;Lewinsohn, Clarke, Seeley, & Rohde, 1994), and, on average, individuals with a history of depression will have five (Kessler & Walters, 1998) to nine (Kessler, Zhao, Blazer, & Swartz, 1997) separate depressive episodes in their lifetime.Due to the fact that depression can be so recurrent, it can have significant personal and public health consequences. For example, one meta-analysis found that the suicide rate among those with depression is approximately twenty times higher than the rate for the general population (Harris & Barraclough, 1997). In addition, a study of over 3000 adolescents and young adults found that 90% of those with recurrent depression reported "very much" impairment, limiting work productivity and social interactions, and 40% sought professional help as a result (Wittchen, Nelson, & Lachner, 1998). Depression can also have a significant economic impact due to decreased productivity in affected individuals (Klerman & Weissman, 1992); in 1996 the annual direct (e.g., visits to doctors, pharmaceutical costs) and indirect (e.g., time...

Functioning before and after a major depressive episode: pre-existing vulnerability or scar? A prospective three-wave population-based study

“…Further, it might be that any scarring already occurred before T0 in those with previous episodes, limiting further scarring. Thus, although it may still be too early to discard the idea that scarring occurs altogethermaybe scarring does occur, but in a subtle way (Wichers et al 2010), in subgroups we did not investigate, or in outcome measures we did not investigate (Burcusa & Iacono, 2007;Bhagwagar & Cowen, 2008) -our study suggests there is no robust scarring effect. In contrast to the scarring effects, the vulnerability effects observed in the present study were robust and substantial.…”

“…MDD is a highly recurrent disorder and risk of recurrence is related to the number of previous episodes (Solomon et al 2000;Kessing et al 2004). This observation stimulated the idea that depressive episodes leave more or less permanent residual impairments or scars that confer risk of subsequent episodes; the 'scar hypothesis' (Rohde et al 1990;Burcusa & Iacono, 2007). Indeed, many studies comparing remitted depressed patients with healthy controls have shown that the former differ in certain ways from the latter (Just et al 2001;Bhagwagar & Cowen, 2008;Paykel, 2008).…”

Potential Impact of Incorporating a Patient-Selected Support Person into mHealth for Depression

“…[7][8][9] This interpersonal element Fig. 1 Probability of adherence by group and call-week may have also helped to offset the potentially impersonal and/ or repetitive nature of automated IVR.…”

“…Because many patients attribute their depression to insufficient social support, 7 and those with high-quality support have better outcomes, 8,9 it may also be beneficial to intensify the self-management support that patients receive from trusted confidants. While their significant others often provide invaluable assistance, these helpers are at high risk for psychological distress.…”

Mood reactivity rather than cognitive reactivity is predictive of depressive relapse: A randomized study with 5.5-year follow-up.

“…Several risk factors for relapse have been identified, for example, early onset, number of previous episodes, residual symptoms, and episode severity (Burcusa & Iacono, 2007;Judd et al, 1998;Kennedy & Paykel, 2004;Paykel, Ramana, Cooper, & Hayhurst, 1995). Potentially modifiable risk factors have been reported as well-including the impact of daily hassles and life events, specific coping styles, decentering, and dysfunctional beliefs (Beshai, Dobson, Bockting, & Quigley, 2011;Bockting, Spinhoven, Koeter, Wouters, & Schene, 2006;Burcusa & Iacono, 2007;Fresco, Segal, Buis, & Kennedy, 2007;Jarrett et al, 2012;ten Doesschate, Bockting, & Schene, 2009).…”