title: Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression.
abstract: BACKGROUND
  Dyadic discord, while common in depression, has not been specifically evaluated as an outcome predictor in chronic major depressive disorder. This study investigated pretreatment dyadic discord as a predictor of non-remission and its relationship to depressive symptom change during acute treatment for chronic depression.
  
  
  METHODS
  Out-patients with chronic depression were randomized to 12 weeks of treatment with nefazodone, the Cognitive Behavioral Analysis System of Psychotherapy or their combination. Measures included the Marital Adjustment Scale (MAS) and the Inventory of Depressive Symptomatology - Self Report (IDS-SR30). Of 681 original patients, 316 were partnered and 171 of these completed a baseline and exit MAS, and at least one post-baseline IDS-SR30. MAS scores were analysed as continuous and categorical variables ('dyadic discord' v. 'no dyadic discord' defined as an MAS score >2.36. Remission was defined as an IDS-SR30 of 14 at exit (equivalent to a 17-item Hamilton Rating Scale for Depression of 7).
  
  
  RESULTS
  Patients with dyadic discord at baseline had lower remission rates (34.1%) than those without dyadic discord (61.2%) (all three treatment groups) (chi2=12.6, df=1, p=0.0004). MAS scores improved significantly with each of the treatments, although the change was reduced by controlling for improvement in depression. Depression remission at exit was associated with less dyadic discord at exit than non-remission for all three groups [for total sample, 1.8 v. 2.4, t(169)=7.3, p<0.0001].
  
  
  CONCLUSIONS
  Dyadic discord in chronically depressed patients is predictive of a lower likelihood of remission of depression. Couple therapy for those with dyadic discord may increase remission rates.
authors.affiliation: Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, TX 75390-9121, USA. Wayne.Denton@UTSouthwestern.edu
authors.forename: W H
authors.initials: WH
authors.lastname: Denton
authors.forename: T J
authors.initials: TJ
authors.lastname: Carmody
authors.forename: A J
authors.initials: AJ
authors.lastname: Rush
authors.forename: M E
authors.initials: ME
authors.lastname: Thase
authors.forename: M H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: B A
authors.initials: BA
authors.lastname: Arnow
authors.forename: D N
authors.initials: DN
authors.lastname: Klein
authors.forename: M B
authors.initials: MB
authors.lastname: Keller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008393:Marriage / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D010879:Piperazines; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012074:Remission Induction; D012650:Self Disclosure; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D010879:Piperazines; D014230:Triazoles; C051752:nefazodone