Prediction of recurrence in recurrent depression and the influence of consecutive episodes on vulnerability for depression: a 2-year prospective study.
OBJECTIVE
Depression is a recurring disease. Identifying risk factors for recurrence is essential. The purpose of this study was to identify factors predictive of recurrence and to examine whether previous depressive episodes influence vulnerability for subsequent depression in a sample of remitted recurrently depressed patients.


METHODS
Recurrence was examined prospectively using the Structured Clinical Interview for DSM-IV Axis I Disorders in 172 euthymic patients with recurrent depression (DSM-IV) recruited from February 2000 through September 2000. Illness-related characteristics, coping, and stress (life events and daily hassles) were examined as predictors.


RESULTS
Risk factors for recurrence were a high number of previous episodes, more residual depressive symptomatology and psychopathology, and more daily hassles. Factors with both an increasing and decreasing pathogenic effect with increasing episode number were detected.


CONCLUSIONS
We found some support for dynamic vulnerability models that posit a change of vulnerability with consecutive episodes. Preventive interventions should be considered in patients with multiple recurrences, focusing on residual symptomatology and specific coping styles.
Bockting
Claudi L H
CL
Department of Psychiatry, Academic Medical Center, University of Amsterdam, Netherlands. c.l.bockting@amc.uva.nl
Spinhoven
Philip
P
Koeter
Maarten W J
MW
Wouters
Luuk F
LF
Schene
Aart H
AH
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004198:Disease Susceptibility / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012008:Recurrence; D012307:Risk Factors; D012917:Social Adjustment