Individuals with certain personality styles - those who are aggressive and those who have low dependency on other people - are at higher risk for recurrent bouts of major depression, according to a new University of Washington study. The results will be presented at the annual meeting of the Association for Advancement of Behavior Therapy in Toronto at noon tomorrow (Nov. 13).
The study comes from the laboratory of UW psychology professor Neil Jacobson, who died last June. Jackie Gollan, his collaborator on the project and lead author of the study, will discuss the findings as part of a panel looking at preventing and predicting relapse of depressed patients.
Gollan and Jacobson also found that people at risk for relapsing reported lower levels of satisfaction or pleasure from their activities than did people who remained well. The study also indicated that a patient's level of negative or dysfunctional thinking at the end of treatment was not predictive of relapse.
"Depression is a recurrent disease for a lot of people just like cancer," said Gollan. "People who receive cognitive behavioral psychotherapy for depression tend to feel less depressed when they complete it. However, other factors in their lives beyond their mood need to be identified if we are to help them stay well. We need to consider who people are and how they interact with others to understand how patients remain nondepressed."
Gollan earned her doctorate in clincial psychology at the UW and is now a clinical psychology intern at Brown University Medical School in Providence, R.I.
Researchers are anxious to identify risk factors for recurrent depression because relapse rates among patients who respond to treatment are alarmingly high. Studies have shown that between 50 percent and 80 percent of patients successfully treated with cognitive behavioral therapy suffer a relapse, often within two years of remission. Cognitive behavioral therapy is the standard treatment for depression, often in conjunction with anti-depressant medication.
Depression is the most common mental health problem in the United States, affecting an estimated 17 million people. Individuals with clinical or major depression, the most serious form of the disorder, often can't function, perform at work, need to be hospitalized and may attempt suicide.
In the new study, Gollan and Jacobson followed 78 patients who had recovered from major depression for two years to monitor changes. The patients all received 20 sessions of cognitive behavioral therapy for their depression and were considered symptom-free for at least two months before being accepted into the study. The researchers utilized a variety of interview questionnaires and self-report forms to measure depression, dysfunctional attitudes and pleasant activities at the beginning and end of treatment and every six months during the two-year follow-up. Personality styles were measured before and after treatment.
At the end of the study, 34 people, or 44 percent, had relapsed. Gollan said there seems to be different subsets of people who are at-risk for recurrent bouts of depression. One of those groups is made up of individuals who have a low dependency on other people. People with low dependency are usually independent people who may have little or no social support system, she said.
"Low dependency increases risk for relapse while moderate dependency encourages recovered patients to seek out social relationships that may function, over time, to reduce relapse risk," she said.
People who exhibited aggressive, hostile styles at the end of treatment also were more likely to relapse, "perhaps because they don't make good friends and turn off people," Gollan explained. "In their professional careers they have channeled aggression in productive, socially acceptable ways to their advantage and use people to their advantage. They also are pathologically independent and independence may be a risk factor if you have depression."
She added that clinicians working with depressed patients need to pay more attention to the enjoyment and satisfaction people get from activities rather than on the type and number of activities they engage in.
"We need to focus on how the activities feel," Gollan said. "We don't know why, but it is becoming clear that people are less at risk for relapse when they do things they enjoy rather than working on overcoming their negative thinking patterns. The treatment should be tailor-made to the depressed patient."
Gollan said the study focused on looking at broad personality styles or patterns rather than clinical personality disorders because many of the people who relapse from depression would not meet strict guidelines for a personality disorder. "We felt assessing personality style on a continuum of severity might generate a broader understanding about factors that predict relapse."
The study was funded by a grant from the National Institute of Mental Health.
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