Modeling relapse in unipolar depression: The effects of dysfunctional cognitions and personality disorders.

Abstract

Survival analytic models were used to determine the effects of Axis II pathology and dysfunctional cognitions on depressive relapse in a sample of 50 depressed inpatients followed 33 to 84 months (M = 49.9) postdischarge. In analyses based on follow-up interview measures, expected remission duration among patients without personality disorders was approximately 7.4 times longer than among patients with Axis II comorbidity. Attributional style also accounted for unique variance in the relapse model, with adaptive positive event attributions inversely related to relapse probability. Neither dysfunctional attitudes nor negative event attributions were significantly related to relapse. Dimensional Axis II Cluster B and C pathology ratings were associated with decreased survival time, whereas Cluster A pathology was associated with increased survival. Among measures obtained during index hospitalization, only the dimensional rating of Axis II pathology was significantly predictive, with a cumulative 8% decrease in expected survival for each Axis II criterion item met.

New episodes and new onsets of major depression in borderline and other personality disorders

“…A third study using 2 year data showed that personality disorders significantly prolonged the time to remission for MDD . That study confirmed the results from earlier work (Ilardi et al, 1997). In general, this literature shows that comorbid personality disorders can negatively affect the course of MDD and that improvements of MDD do not usually affect the course of personality disorders.…”

Interpersonal Competence Across Domains: Relevance to Personality Pathology

“…BDI-II scores were, on average, in the mildly symptomatic range, similar to other studies which have sampled a remitted depressed adult population (Hart, Craighead, & Craighead, 2001;Ilardi, Craighead, & Evans, 1997). IPDE total dimensional scores were somewhat lower than found previously in a similar population (Hart et al, 2001).…”

Two-Year Prospective Naturalistic Study of Remission From Major Depressive Disorder as a Function of Personality Disorder Comorbidity.

“…These PDs emerged as robust predictors of slowed remission from MDD even when controlling for other negative prognostic predictors. In this ongoing CLPS study, future analyses will attempt to delineate factors that might influence the timing of changes-such as relapses (Ilardi et al, 1997) and associated changes (e.g., life events, treatment, psychosocial functioning)-and how these factors contribute to the longer-term course of depression. Survival curves (time to remission) for major depressive disorder (MDD) as a function of personality disorder comorbidity.…”

“…Many studies, but not all, have suggested that PDs may have a negative impact on the course or outcome of Axis I disorders Grilo, McGlashan, & Oldham, 1998). For instance, some research has found that PDs predict development of depression (Alnaes & Torgersen, 1997), poorer response to treatment for depression (Mulder, 2002), and relapse to depression (Hart, Craighead, & Craighead, 2001;Ilardi, Craighead, & Evans, 1997).…”