title: Response style and severity and chronicity of depressive disorders in primary health care.
abstract: BACKGROUND
  Response styles theory of depression postulates that rumination is a central factor in occurrence, severity and maintaining of depression. High neuroticism has been associated with tendency to ruminate. We investigated associations of response styles and neuroticism with severity and chronicity of depression in a primary care cohort study.
  
  
  METHODS
  In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II interviews. Of the 137 patients with depressive disorders, 82% completed the prospective five-year follow-up with a graphic life chart enabling evaluation of the longitudinal course of episodes. Neuroticism was measured with the Eysenck Personality Inventory (EPI-Q). Response styles were investigated at five years using the Response Styles Questionnaire (RSQ-43).
  
  
  RESULTS
  At five years, rumination correlated significantly with scores of Hamilton Depression Rating Scale (r=0.54), Beck Depression Inventory (r=0.61), Beck Anxiety Inventory (r=0.50), Beck Hopelessness Scale (r=0.51) and Neuroticism (r=0.58). Rumination correlated also with proportion of follow-up time spent depressed (r=0.38). In multivariate regression, high rumination was significantly predicted by current depressive symptoms and neuroticism, but not by anxiety symptoms or preceding duration of depressive episodes.
  
  
  CONCLUSIONS
  Among primary care patients with depression, rumination correlated with current severity of depressive symptoms, but the association with preceding episode duration remained uncertain. The association between neuroticism and rumination was strong. The findings are consistent with rumination as a state-related phenomenon, which is also strongly intertwined with traits predisposing to depression.
authors: Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland; Health Care and Social Services, City of Järvenpää, PL 41, 04401 Järvenpää, Finland.
authors: K
authors: K
authors: Riihimäki
authors: Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O.Box 900, 00029 HUS, Helsinki, Finland.
authors: M
authors: M
authors: Vuorilehto
authors: Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O.Box 900, 00029 HUS, Helsinki, Finland.
authors: P
authors: P
authors: Jylhä
authors: Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O.Box 900, 00029 HUS, Helsinki, Finland. Electronic address: erkki.isometsa@hus.fi.
authors: E
authors: E
authors: Isometsä
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001008:Anxiety Disorders / Q000175:diagnosis; D003863:Depression / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D000075384:Neuroticism; D010555:Personality Inventory; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011897:Random Allocation; D012959:Socioeconomic Factors; D013223:Statistics as Topic; D011795:Surveys and Questionnaires
keywords: Comorbidity; Depression; Neuroticism; Primary care; Response style; Rumination