Outcome of dysthymic disorder at 5-year follow-up: the effect of familial psychopathology, early adversity, personality, comorbidity, and chronic stress.
OBJECTIVE
This study sought to identify predictors of course and outcome in dysthymic disorder.


METHODS
Eighty-six outpatients with early-onset dysthymic disorder (before age 21) participated in a prospective 5-year follow-up study. Family history of psychopathology, early home environment, axis I and II comorbidity, social support, and chronic stress were assessed at baseline. The Longitudinal Interval Follow-up Evaluation and the Hamilton Depression Rating Scale were used in the follow-up assessments conducted at 30 and 60 months.


RESULTS
Comorbid anxiety disorder, cluster C and depressive personality features, and chronic stress were associated with a lower rate of recovery from dysthymic disorder, while family history of bipolar disorder was associated with a higher probability of recovery. Family history of dysthymic disorder, poor childhood maternal and paternal relationships, childhood sexual abuse, cluster C features, neuroticism, a history of anxiety and eating disorders, and chronic stress predicted higher levels of depression at follow-up. Multivariate models indicated that almost all domains contributed to the prediction of course and outcome.


CONCLUSIONS
The course and outcome of dysthymic disorder is best conceptualized within a multifactorial framework, with family history of psychopathology, early adversity, axis I and II comorbidity, and chronic stress all making important contributions.
Hayden
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EP
Department of Psychology, State University of New York at Stony Brook, 11794-2500, USA.
Klein
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DN
D000328:Adult; D002908:Chronic Disease; D015897:Comorbidity; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics*; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology*; D010555:Personality Inventory; D011446:Prospective Studies; D012649:Self Concept; D012720:Severity of Illness Index; D012931:Social Environment; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires