Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-25T19:24:42.514Z Has data issue: false hasContentIssue false
  • English
  • Français

The long-term course of depression: development of an empirical index and identification of early adult outcomes

Published online by Cambridge University Press:  08 July 2008

J. W. Pettit ,
P. M. Lewinsohn ,
R. E. Roberts ,
J. R. Seeley  and
L. Monteith
J. W. Pettit*
Affiliation:
University of Houston, Houston, TX, USA
P. M. Lewinsohn
Affiliation:
Oregon Research Institute, Eugene, OR, USA
R. E. Roberts
Affiliation:
University of Texas Health Science Center, Houston, TX, USA
J. R. Seeley
Affiliation:
Oregon Research Institute, Eugene, OR, USA
L. Monteith
Affiliation:
University of Houston, Houston, TX, USA
*
*Address for correspondence: Dr J. W. Pettit, Department of Psychology, 126 Heyne Building, University of Houston, Houston, TX 77204-5022, USA. (Email: jpettit@uh.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Research on the long-term course of major depressive disorder (MDD) is hindered by the absence of established course criteria and by idiosyncratic definitions of chronicity. The aims of this study were to derive an empirical index of MDD course, to examine its predictive validity, and to identify the adulthood outcomes associated with a chronic course.

Method

Indicators for a MDD course factor were rationally selected and subjected to principal components (PCA) and confirmatory factor analyses (CFA) among 426 subjects with a lifetime history of MDD by age 30. Scores on the index prior to age 19 were examined as predictors of course from age 19 to 30. Associations between the index and outcomes of interest at age 30 were examined.

Results

Three indicators loaded highly on a chronic course index and displayed adequate internal consistency: early onset age, number of episodes, and duration of ill time. Predictive validity of the index was supported. A more chronic course was associated with greater symptom severity, greater likelihood of treatment utilization, and greater psychosocial impairment in multiple domains. Treatment utilization interacted with chronicity to predict relatively few outcomes and did not reduce the negative impact of a chronic course.

Conclusions

The course of MDD through early adulthood is best represented by a composite of early onset age, number of episodes, and duration of ill time. A chronic course through early adulthood is associated with numerous indicators of psychosocial impairment. Mental health treatment utilization in a naturalistic setting does not appear to reduce the negative impact of chronic MDD.

Keywords

Chroniccoursedepressionearly onsetoutcomesrecurrence
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 3 , March 2009 , pp. 403 - 412
Copyright
Copyright © 2008 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andrews, JA, Lewinsohn, PM, Hops, H, Roberts, RE (1993). Psychometric properties of scales for the measurement of psychosocial variables associated with depression in adolescence. Psychological Reports 73, 1019–1046.Google ScholarPubMed
Berndt, ER, Koran, LM, Finkelstein, SN, Gelenberg, AJ, Kornstein, SG, Miller, IM, Thase, ME, Trapp, GA, Keller, MB (2000). Lost human capital from early-onset chronic depression. American Journal of Psychiatry 157, 940–947.CrossRefGoogle ScholarPubMed
Birmaher, B, Arbelaez, C, Brent, D (2002). Course and outcome of child and adolescent major depressive disorder. Child and Adolescent Psychiatric Clinics of North America 11, 619–637.CrossRefGoogle ScholarPubMed
Cohen, J, Cohen, P (1983). Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum: Hillsdale, NJ.Google Scholar
Crown, W, Finkelstein, S, Brendt, E, Ling, D, Poret, AW, Rush, J, Russell, JM (2002). The impact of treatment-resistant depression in health care utilization and costs. Journal of Clinical Psychiatry 63, 963–971.CrossRefGoogle ScholarPubMed
Dalrymple, KL, Zimmerman, M (2007). Does comorbid social anxiety disorder impact the clinical presentation of principal major depressive disorder? Journal of Affective Disorders 100, 241–247.CrossRefGoogle ScholarPubMed
Dunn, V, Goodyer, IM (2006). Longitudinal investigation into childhood and adolescent onset depression: psychiatric outcome in early adulthood. British Journal of Psychiatry 188, 216–222.CrossRefGoogle ScholarPubMed
Folkman, S, Lazarus, RS (1980). An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior 21, 219–239.CrossRefGoogle Scholar
Garyfallos, G, Adamopoulou, A, Karastergiou, A, Voikli, M, Sotiropoulou, A, Donias, S, Giouzepas, J, Paraschos, A (1999). Personality disorders in dysthymia and major depression. Acta Psychiatrica Scandinavica 99, 332–340.CrossRefGoogle ScholarPubMed
Gilmer, WS, Trivedi, MH, Rush, AJ, Wisniewski, SR, Luther, J, Howland, RH, Yohanna, D, Khan, A, Alpert, J (2005). Factors associated with chronic depressive episodes: a preliminary report from the STAR*D project. Acta Psychiatrica Scandinavica 112, 425–433.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology and Neurosurgery 23, 56–61.Google ScholarPubMed
Harter, S (1982). The Perceived Competence Scale for Children. Child Development 53, 87–97.CrossRefGoogle Scholar
Hasin, DS, Tsai, WY, Endicott, J, Mueller, TI, Coryell, W, Keller, M (1996). Five-year course of major depression: effects of comorbid alcoholism. Journal of Affective Disorders 41, 63–70.CrossRefGoogle ScholarPubMed
Hays, JC, Krishnan, KR, George, LK, Pieper, CF, Flint, EP, Blazer, DG (1997). Psychosocial and physical correlates of chronic depression. Psychiatry Research 72, 149–159.CrossRefGoogle ScholarPubMed
Holmes, TH, Rahe, RH (1967). The social readjustment rating scale. Journal of Psychosomatic Research 11, 213–218.CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Zeller, PJ, Paulus, M, Leon, AC, Maser, JD, Endicott, J, Corvell, W, Kunovac, JL, Mueller, TI, Rice, JP, Keller, MB (2000). Psychosocial disability during the long-term course of unipolar major depressive disorder. Archives of General Psychiatry 57, 375–380.CrossRefGoogle ScholarPubMed
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E (1987). The longitudinal interval follow-up evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.CrossRefGoogle ScholarPubMed
Keller, MB, McCullough, JP, Klein, DN, Arnow, BL, Duner, DL, Gelenberg, AJ, Markowitz, JC, Nemeroff, CB, Russell, JM, Thase, ME, Trivedi, MH, Zajecka, J (2000). A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine 342, 1462–1470.CrossRefGoogle ScholarPubMed
Klein, DN (in press). Classification of depressive disorders in DSM-V: proposal for a two-dimension system. Journal of Abnormal Psychology.Google Scholar
Klein, DN, Lewinsohn, PM, Rohde, P, Seeley, JR, Durbin, CE (2002). Clinical features of major depressive disorder in adolescents and their relatives: impact on familial aggregation, implications for phenotype definition and specificity of transmission. Journal of Abnormal Psychology 111, 98–106.CrossRefGoogle ScholarPubMed
Klein, DN, Shankman, AS, Lewinsohn, PM, Rohde, P, Seeley, JR (2004). Family study of chronic depression in a community sample of young adults. American Journal of Psychiatry 161, 646–653.CrossRefGoogle Scholar
Lewinsohn, PM, Hops, H, Roberts, RE, Seeley, JR, Andrews, JA (1993). Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology 102, 133–144.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Mermelstein, RM, Alexander, C, MacPhillamy, D (1985). The Unpleasant Events Schedule: a scale for the measurement of aversive events. Journal of Clinical Psychology 41, 483–498.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Mischel, W, Chaplin, W, Barton, R (1980). Social competence and depression: the role of illusory self-perceptions. Journal of Abnormal Psychology 89, 203–212.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Roberts, RE, Seeley, JR, Rohde, P, Gotlib, IH, Hops, H (1994). Adolescent psychopathology: II. Psychosocial risk factors for depression. Journal of Abnormal Psychology 103, 302–315.CrossRefGoogle ScholarPubMed
Markowitz, JC, Moran, ME, Kocsis, JH, Frances, AJ (1992). Prevalence and comorbidity of dysthymic disorder. Journal of Affective Disorders 24, 63–71.CrossRefGoogle ScholarPubMed
McCullough, JP, Klein, DN, Borian, FE, Howland, RH, Riso, LP, Keller, MB, Banks, PLC (2003). Group comparisons of DSM–IV subtypes of chronic depression: validity of the distinctions, Part 2. Journal of Abnormal Psychology 112, 614–622.CrossRefGoogle ScholarPubMed
Merikangas, KR, Wicki, W, Angst, J (1994). Heterogeneity of depression. Classification of depressive subtypes by longitudinal course. British Journal of Psychiatry 164, 342–348.CrossRefGoogle ScholarPubMed
Mondimore, FM, Zandi, PP, MacKinnon, DF, McInnis, MG, Miller, EB, Crowe, RP, Scheftner, WA, Marta, DH, Weissman, MM, Levinson, DF, Murphy-Ebenez, KP, DePaulo, JR, Potash, JB (2006). Familial aggregation of illness chronicity in recurrent, early-onset major depression pedigrees. American Journal of Psychiatry 163, 1554–1560.CrossRefGoogle ScholarPubMed
Mondimore, FM, Zandi, PP, MacKinnon, DF, McInnis, MG, Miller, EB, Schweizer, B, Crowe, RP, Scheftner, WA, Weissman, MM, Levinson, DF, DePaulo, JR, Potash, JB (2007). A comparison of the familiality of chronic depression in recurrent early-onset depression pedigrees using different definitions of chronicity. Journal of Affective Disorders 100, 171–177.CrossRefGoogle ScholarPubMed
Orvaschel, H, Puig-Antich, J, Chambers, WJ, Tabrizi, MR, Johnson, R (1982). Retrospective assessment of prepubertal major depression with the Kiddie-SADS-E. Journal of the American Academy of Child and Adolescent Psychiatry 21, 392–397.Google ScholarPubMed
Parker, GB, Brown, LB (1979). Repertoires of response to potential precipitants of depression. Australian and New Zealand Journal of Psychiatry 13, 327–333.CrossRefGoogle ScholarPubMed
Pettit, JW, Lewinsohn, PM, Joiner, TE Jr. (2006). Propagation of major depressive disorder: relationship between first episode symptoms and recurrence. Psychiatry Research 141, 271–278.CrossRefGoogle ScholarPubMed
Procidano, ME, Heller, K (1983). Measures of perceived social support from friends and from family: three validation studies. American Journal of Community Psychology 11, 1–24.CrossRefGoogle ScholarPubMed
Radloff, LS (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.CrossRefGoogle Scholar
Rohde, P, Lewinsohn, PM, Klein, DN, Seeley, JR (2005). Association of parental depression with psychiatric course from adolescence to young adulthood among formerly depressed individuals. Journal of Abnormal Psychology 114, 409–420.CrossRefGoogle ScholarPubMed
Rohde, P, Lewinsohn, PM, Seeley, JR (1997). Comparability of telephone and face-to-face interviews assessing Axis I and II disorders. American Journal of Psychiatry 154, 1593–1598.CrossRefGoogle ScholarPubMed
Rosenberg, M (1965). Society and the Adolescent Self-Image. Princeton University Press: Princeton, NJ.CrossRefGoogle Scholar
Sandler, IN, Block, M (1979). Life stress and maladaption of children. American Journal of Community Psychology 7, 425–439.CrossRefGoogle ScholarPubMed
Schatzberg, AF, Rush, AJ, Arnow, BA, Banks, PL, Blalock, JA, Borian, FE, Howland, R, Klein, DN, Kocsis, JH, Kornstein, SG, Manber, R, Markowitz, JC, Miller, I, Ninan, PT, Rothbaum, BO, Thase, ME, Trivedi, MH, Keller, MB (2005). Chronic depression: medication (nefazodone) or psychotherapy (CBASP) is effective when the other is not. Archives of General Psychiatry 62, 513–520.CrossRefGoogle ScholarPubMed
Scheier, MF, Carver, CS, Bridges, MW (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a re-evaluation of the Life Orientation Test. Journal of Personality and Social Psychology 67, 1063–1078.CrossRefGoogle Scholar
Shankman, S, Klein, D (2002). The impact of comorbid anxiety disorders on the course of dysthymic disorder: a 5-year prospective longitudinal study. Journal of Affective Disorders 70, 211–217.CrossRefGoogle ScholarPubMed
Sobin, E, Weissman, MM, Goldstein, RB, Adams, P, Wickramaratne, P, Warner, V, Lish, JD (1993). Diagnostic interviewing for family studies: comparing telephone and face-to-face methods for the diagnosis of lifetime psychiatric disorders. Psychiatric Genetics 3, 227–233.CrossRefGoogle Scholar
Solomon, DA, Leon, AC, Endicott, J, Mueller, TI, Coryell, W, Shea, MT, Keller, MB (2004). Psychosocial impairment and recurrence of major depression. Comprehensive Psychiatry 45, 423–430.CrossRefGoogle ScholarPubMed
Spijker, J, De Graaf, R, Bijl, RV, Beekman, ATF, Ormel, J, Nolen, WA (2004). Determinants of persistence of major depressive episodes in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Journal of Affective Disorders 81, 231–240.CrossRefGoogle ScholarPubMed
Watkins, KE, Paddock, SM, Zhang, L, Wells, KB (2006). Improving care for depression in patients with comorbid substance misuse. American Journal of Psychiatry 163, 125–132.CrossRefGoogle ScholarPubMed
Weissman, MM, Bothwell, S (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry 33, 1111–1115.CrossRefGoogle ScholarPubMed
Zalsman, G, Brent, DA, Weersing, VR (2006). Depressive disorders in childhood and adolescence: an overview. Epidemiology, clinical manifestation and risk factors. Child and Adolescent Psychiatric Clinics of North America 15, 827–841.CrossRefGoogle ScholarPubMed
Zimmerman, M, Chelminski, I, Zisook, S, Ginsberg, DL (2006). Recognition and treatment of depression with or without comorbid anxiety disorders. Primary Psychiatry 13, 1–13.Google Scholar
Zisook, S, Rush, AJ, Albala, A, Alpert, J, Balasubramani, GK, Fava, M, Husain, M, Sackeim, H, Trivedi, M, Wisniewski, S (2004). Factors that differentiate early vs. later onset of major depression disorder. Psychiatry Research 129, 127–140.CrossRefGoogle ScholarPubMed