Life stress and treatment course of recurrent depression: II. Postrecovery associations with attrition, symptom course, and recurrence over 3 years

Do Life Events and Social Support Vary across Depressive Disorders?

BACKGROUND

Social support and life events moderate the expression of depression though studies have shown contradictory results. The objective was to study the stressful life events and perceived social support in patients with adjustment disorder, first-episode depression, and recurrent depressive disorder (RDD).

SUBJECTS AND METHODS

One hundred and forty-six patients aged 18-60 years with adjustment disorder, first-episode depression, or RDD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were evaluated using the presumptive stressful life events scale and Multidimensional Scale of Perceived Social Support.

RESULTS

There was no difference in mean number of total life events and subgroups as well as perceived stress score in the past 1 year between the groups. There was no difference in the perceived social support scale total score, as well as from family and friends, across the three groups. However, the mean perceived social support from significant others in those with RDD was lower as compared to those with adjustment disorder.

CONCLUSION

Stressful life events do not differ in adjustment disorder, first-episode depression, and RDD. Furthermore, the perceived social support was similar across the three groups, except for perceived social support from significant others, which was less in those with RDD.

A two-factor model of relapse/recurrence vulnerability in unipolar depression

The substantial health burden associated with major depressive disorder (MDD) is a product of both its high prevalence and the significant risk of relapse, recurrence, and chronicity. Establishing recurrence vulnerability factors (VFs) could improve the long-term management of MDD by identifying the need for further intervention in seemingly recovered patients. We present a model of sensitization in depression vulnerability, with an emphasis on the integration of behavioral and neural systems accounts. Evidence suggests that VFs fall into 2 categories: dysphoric attention and dysphoric elaboration. Dysphoric attention is driven by fixation on negative life events, and is characterized behaviorally by reduced executive control, and neurally by elevated activity in the brain's salience network. Dysphoric elaboration is driven by rumination that promotes overgeneral self- and contextual appraisals, and is characterized behaviorally by dysfunctional attitudes, and neurally by elevated connectivity within normally distinct prefrontal brain networks. Although few prospective VF studies exist from which to catalogue a definitive neurobehavioral account, extant data support the value of the proposed 2-factor model. Measuring the continued presence of these 2 VFs during recovery may more accurately identify remitted patients who would benefit from targeted prophylactic intervention.

The scars of childhood adversity: minor stress sensitivity and depressive symptoms in remitted recurrently depressed adult patients

Background

Childhood adversity may lead to depressive relapse through its long-lasting influence on stress sensitivity. In line with the stress sensitization hypothesis, minor (daily) stress is associated with depressive relapse. Therefore, we examine the impact of childhood adversity on daily stress and its predictive value on prospectively assessed depressive symptoms in recurrently depressed patients.

Method

Daily stress was assessed in recurrently depressed adult patients, enrolled into two randomized trials while remitted. The reported intensity and frequency of dependent and independent daily stress was assessed at baseline. Independent stress is externally generated, for example an accident happening to a friend, while dependent stress is internally generated, for example getting into a fight with a neighbor. Hierarchical regression analyses were performed with childhood adversity, independent and dependent daily stress as predictor variables of prospectively measured depressive symptoms after three months of follow-up (n = 138).

Results

We found that childhood adversity was not significantly associated with a higher frequency and intensity of daily stress. The intensity of both independent and dependent daily stress was predictive of depressive symptom levels at follow-up (unadjusted models respectively: B = 0.47, t = 2.05, p = 0.041, 95% CI = 0.02–0.92; B = 0.29, t = 2.20, p = 0.028, 95% CI = 0.03–0.55). No associations were found between childhood adversity and depressive symptoms at follow-up.

Conclusion

No evidence was found supporting stress sensitization due to the experience of childhood adversity in this recurrently depressed but remitted patient group. Nevertheless, our research indicates that daily stress might be a target for preventive treatment.

Trial Registration

Trial A: Nederlands Trial Register NTR1907 Trial B: Nederlands Trial Register NTR2503

The cumulative impact of nonsevere life events predicts depression recurrence during maintenance treatment with interpersonal psychotherapy

Although much research has focused on the role of severe life events as risk factors for depression onset, less is known about the relationship between nonsevere life events and depression recurrence. The current study examined the cumulative effects of nonsevere and positive life events on depression recurrence in an outpatient sample of recurrently depressed women treated to remission with interpersonal psychotherapy (IPT). A Cox proportional hazards model was used to test this relationship in 124 adult women who entered into the maintenance phase of IPT treatment and completed at least 1 Life Events and Difficulties Schedule interview. The cumulative experience of nonsevere life events that were subject- or joint-focused and nonindependent was significantly related to depression recurrence during the maintenance treatment phase. None of the other event categories were significantly related to depression recurrence. These findings may help to clarify the mechanisms by which life events contribute to depression recurrence and to guide the development of more efficacious maintenance treatments.