Deterioration in psychosocial functioning predicts relapse/recurrence after cognitive therapy for depression

Moderators of continuation phase cognitive therapy's effects on relapse, recurrence, remission, and recovery from depression

The authors investigated the theoretical and clinical role of depression among cocaine abusers in treatment. Eighty-nine cocaine-abusing patients underwent 2 weeks of substance abuse treatment. Posttreatment major depressive disorder, depressive symptoms before and after substance abuse treatment, and alcohol diagnoses were assessed and their relation to pretreatment substance use, cravings in high-risk situations, and 3-month follow-up status was examined. High rates of major depressive disorder were found but were unrelated to pretreatment substance use. The decrease in depressive symptoms during treatment was independent of major depressive disorder or alcohol diagnoses and predicted treatment attrition. Higher levels of depressive symptoms during treatment were associated with greater urge to use cocaine, alcohol, and other drugs in high-risk situations. Concurrent major depressive disorder and depressive symptoms did not predict cocaine use at follow-up. However, patients who had an alcohol relapse episode experienced more depressive symptoms during treatment than did those who abstained. The results highlight the relationship of depression to alcohol use among cocaine abusers and suggest a need for further studies of the association between depression and substance use disorders.

This study aimed to understand the role of disinhibition (low conscientiousness)-in conjunction with the other major personality traits of negative affectivity, detachment, antagonism, and psychoticism-in predicting changes in depressive symptoms and psychosocial functioning. Both the disinhibition trait domain and its primary facets (i.e., irresponsibility, impulsivity, and distractibility) were examined. In a large sample (Time 1 N = 605, Time 2 N = 497) of psychiatric outpatients and high-risk community residents, personality traits, depressive symptoms (both self-reported and interviewer-rated), and psychosocial functioning levels (i.e., daily functioning, interpersonal functioning, health-related quality of life, and global quality of life) were collected across two time points. Results showed that the disinhibition domain was the strongest predictor of changes in depressive symptoms and general quality of life levels. Disinhibition facets also predicted changes in depressive symptoms but showed a less consistent pattern compared to the broader trait domain. Finally, the irresponsibility and distractibility facets significantly and uniquely explained changes in interpersonal functioning. The study highlights the importance of assessing the disinhibition trait rather than only negative and positive affectivity (which are well-known correlates of depression), for understanding changes in depressive symptoms and psychosocial functioning. The findings identify potential targets in psychotherapy for individuals with disinhibition traits and depressive disorders.

Longitudinal studies have rarely investigated changes in depressive symptoms and indicators of obesity simultaneously, although it is often proposed that the positive relationship between depression and obesity is bidirectional. The present study examined the reciprocal nature of the relationship between depressive symptoms and body mass index (BMI) in a 20-year follow-up survey. Participants of a Finnish cohort study in 1989 at 22 years (N=1656) were followed up at ages 32 (N=1262) and 42 (N=1155) with postal questionnaires. BMI was calculated on the basis of self-reported weight and height, and depressive symptoms were assessed using the short form of the Beck Depression Inventory. Latent growth models (LGM) and cross-lagged autoregressive models were used to determine prospective associations between depressive symptoms and BMI. LGM analyses indicated that men with higher initial levels of depressive symptoms experienced a faster rate of increase in BMI (β=0.20, P<0.01). Among women, change in BMI or depressive symptoms was not predicted by the other construct, but initial levels of BMI and depressive symptoms as well as their rate of change correlated positively with each other (r=0.15 and 0.37, respectively). In cross-lagged models, depressive symptoms at age 32 predicted greater BMI at 42 (β=0.10, P<0.001) among men, whereas women with higher BMI at age 32 were more likely to have more depressive symptoms at 42 (β=0.08, P<0.05). Elevated depressive symptoms predicted weight gain in men, while changes in depressive symptoms and body weight occurred concurrently in women. Tentative evidence showed that women with excess body weight were more likely to have increased symptoms of depression 10 years later. More emphasis should be placed on depressive symptoms in weight control programs as well as on reducing weight-based stigmatization and discrimination in society.

Impact of obsessive-compulsive disorder on quality of life

Acute-phase cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD) producing benefits comparable to pharmacotherapy, but not all patients respond or remit. The purpose of the current analyses was to estimate CT patients' probability of nonresponse and remission from symptom improvement early in treatment. Data from 2 clinical trials of acute-phase CT for recurrent depression were pooled for analysis (N = 679). Adult outpatients received 16- or 20-session CT protocols. Symptoms were measured repeatedly with the clinician-report Hamilton Rating Scale for Depression (HRSD) and Inventory of Depressive Symptomatology-Self-Report (IDS-SR). Outcomes at exit from CT were nonresponse (<50% reduction in HRSD scores) and remission (no MDD and HRSD score ≤6). The nonresponse rate was 45.7%, and the remission rate was 33.4%. In logistic regression models, improvements on the HRSD or IDS-SR from intake to CT Sessions 3, 5, 7, 9, or 11 significantly predicted both outcomes, with prediction gaining in accuracy in later sessions. Clinician and self-report assessments yielded similar results. Prediction of outcomes replicated across data sets. Patients with no symptom improvement by CT Session 9 (Week 5) had ≤10% probability of remission and >75% probability of nonresponse. Outcomes of CT for depression are predictable from early symptom changes. Clinicians may find nonresponse and remission probability estimates useful in the informed consent process and in choosing whether to continue, augment, or switch treatments for CT patients with recurrent MDD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Despite a well-established literature on the protective effect of education on health, less is known about group differences in the mechanisms underlying this association. Using a life course approach and cumulative advantage theory, this study compared Black men, Black women, White men, and White women to assess the long-term gradient (education as a continuous measure) and threshold (>12years) effects of baseline education on change in chronic medical conditions (CMC) and depressive symptoms (DS) from baseline to 25years later. Data came from the Americans' Changing Lives Study, 1986-2011. The study followed Black and White respondents for up to 25years, among whom 1271 individuals who had survived and were under follow-up were interviewed in 2011 and reported their number of chronic medical conditions and depressive symptoms (Center for Epidemiological Studies-Depression; CES-D 11). Multi-group structural equation modeling was used to compare gradient and threshold effects of education on change in chronic medical conditions and depressive symptoms from baseline (1986) to 25years later (2011) among Black men, Black women, White men, and White women. There were group differences in the long-term association between education measured as a gradient and the change in depressive symptoms and chronic medical conditions during the follow-up, and in the association between education measured at the threshold of 12years on change in depressive symptoms from baseline to follow-up. However, the association between education measured at this threshold and change in chronic medical conditions did not differ across race-gender groups. With the exception of Black men, who showed a gradient protective effect for baseline education against increase in the number of chronic medical associations (threshold or gradient) with change in chronic medical conditions. Among White men and White women, education had a threshold protective effect against increase in depressive symptoms from baseline to 25years later. Black men and women showed a gradient protective effect of baseline education against an increase in depressive symptoms over the 25-year follow-up period, but unexpectedly, a threshold effect of education was also found to be associated with an increase in depressive symptoms over the follow-up period among Black men. This finding suggests that although Black men benefit from each incremental increase in education, those who graduated from high school were at an additional risk of depressive symptoms over a 25-year period. Findings suggest that the intersection of race and gender influences how education is associated with long-term changes in physical and mental health of individuals from baseline to 25years later. As the shape of the association between education and health depends on the intersection of race and gender, these groups may vary for operant mechanisms by which education operates as a main social determinant of health.

Functional impairments are a common concern for individuals with major depressive disorder (MDD) that does not resolve with initial antidepressant treatment. Such concerns include cognitive difficulties, such as impaired executive functions, which can be particularly disruptive to daily function. There is a need to evaluate potential augmentation strategies for depressed individuals who do not adequately respond to initial antidepressant treatment. Aripiprazole is an FDA-approved adjunctive treatment to antidepressants for MDD, and because of its effect on both dopaminergic and serotonergic systems, may be of particular benefit to cognitive functioning. This study evaluated depressive symptom severity, cognitive function, and psychosocial function before and after six weeks of open-label aripiprazole augmentation treatment in patients with MDD who did not fully respond to selective serotonin reuptake inhibitor treatment. Participants endorsed difficulty with concentration and decision-making at study entry. Significant decreases were observed for depressive symptoms, and significant increases were found in executive function measures and measures of psychosocial function and quality of life. These preliminary data suggest that aripiprazole augmentation may yield functional benefits when used as an adjunctive treatment in MDD, and support the need for further investigation of aripiprazole and other augmentation strategies to specifically evaluate functional outcomes in MDD.

Little is known about the development and course of depressive symptoms through emerging adulthood among individuals with a childhood history of attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to examine if a history of ADHD in childhood significantly predicted depressive symptoms during emerging adulthood (i.e., ages 18-25 years), including the initial level of depressive symptoms, continued levels of depressive symptoms at each age year, and the rate of change in depressive symptoms over time. 394 participants (205 with ADHD and 189 without ADHD; 348 males and 46 females) drawn from the Pittsburgh ADHD Longitudinal Study (PALS) completed annual self-ratings of depressive symptoms between the ages of 18 and 25years. Childhood history of ADHD significantly predicted a higher initial level of depressive symptoms at age 18, and higher levels of depressive symptoms at every age year during emerging adulthood. ADHD did not significantly predict the rate of change in depressive symptoms from age 18 to age 25. Childhood history of ADHD remained a significant predictor of initial level of depressive symptoms at age 18 after controlling for comorbid psychiatric diagnoses, but not after controlling for concurrent ADHD symptoms and psychosocial impairment. Participants with childhood histories of ADHD experienced significantly higher levels of depressive symptoms than non-ADHD comparison participants by age 18 and continued to experience higher, although not increasing, levels of depressive symptoms through emerging adulthood. Clinical implications and directions for future research are discussed.

Mindfulness and ruminative thinking have been shown to mediate the effects of mindfulness-based treatments on depressive symptoms. Yet, the dynamic interplay between these variables in daily life during mindfulness-based treatment has received little attention. The present study focuses on the sequence of daily changes taking place within individuals during a mindfulness-based treatment. Using a replicated single-subject time-series design, we examined the within-person temporal associations between day-to-day changes in mindfulness, repetitive thinking, and depressive symptoms. Study participants were six women with depressive symptoms who filled out diary questionnaires during a mindfulness-based treatment. A separate vector autoregressive (VAR) model was estimated for each participant. Changes in mindfulness and repetitive thinking preceded changes in depressive symptoms in a few of the six participants. We did not find evidence for reverse causality: changes in depressive symptoms did not predict later changes in mindfulness or repetitive thinking in any of the participants. These results are in accordance with the assumed causal chain of change underlying mindfulness-based treatments. Furthermore, all individuals showed moderate to strong concurrent (within-day) associations between the variables. Possible explanations for this finding include that change processes occur within the day or that the daily self-reports of mindfulness, repetitive thinking, and depressive symptoms overlap and reflect a common underlying state of mind.

Standard clinical trial methodology in depression does not allow for careful examination of early changes in symptom intensity. The purpose of this study was to use daily "Mental Health Telemetry" (MHT) to prospectively record change in depressive and anxiety symptoms for depressed patients receiving augmentation treatment, and determine the extent and predictive capacity of early changes. We report results of a 6-week, open-label study of the addition of quetiapine XR (range, 50-300 mg) for adult patients (n = 26) with major depressive disorder who were nonresponsive to antidepressant treatment. In addition to regular study visits, all participants completed daily, wirelessly transmitted self-report ratings of symptoms on a Smartphone. Daily and 3-day moving average mean scores were calculated, and associations between early symptom change and eventual response to treatment were determined. Improvement in depressive and anxiety symptoms was identified as early as day 1 of treatment. Of the total decline in depression severity over 6 weeks, 9% was present at day 1, 28% at day 2, 39% at days 3 and 4, 65% at day 7, and 80% at day 10. Self-report rating of early improvement (≥20%) in depressive symptoms at day 7 significantly predicted responder status at week 6 (P = 0.03). Clinician-rated depressive and anxiety symptoms only became significantly associated with responder status at day 14. In conclusion, very early changes in depressive symptoms were identified using MHT, early changes accounted for most of total change, and MHT-recorded improvement as early as day 7 significantly predicted response to treatment at study end point.

BackgroundDepression is one of the leading causes of disability worldwide and is a major contributor to the overall global burden of disease among older adults. Using polygenic score (PGS) analyses,...

The impact of depression on the treatment of obsessive–compulsive disorder: Results from a 5-year follow-up

Patients with major depressive disorder (MDD) and a comorbid personality disorder (PD) have been found to exhibit relatively poor outcomes in cognitive therapy (CT) and other treatments. Adaptations of CT focusing heavily on patients' core beliefs have yielded promising findings in the treatment of PD. However, there have been no investigations that have specifically tested whether increased focus on maladaptive beliefs contributes to CT's efficacy for these patients. CT technique use from an early CT session was assessed for 59 patients (33 without PD, 26 with PD-predominantly Cluster C) who participated in a randomized controlled trial for moderate to severe MDD. Scores were calculated for directive CT techniques (CT-Concrete) and a set of belief-focused items (CT-Belief) as rated by the Collaborative Study Process Rating Scale. Robust regressions were conducted to estimate relations between scores on each of these measures and change in depressive and PD symptoms. A PD status by CT-Belief use interaction tested the hypothesis that therapist use of CT-Belief techniques would exhibit a stronger association with symptom change in the PD group relative to the non-PD group. As hypothesized, a significant interaction between PD status and use of CT-Belief techniques emerged in the prediction of depressive and PD symptom change. Among PD patients, higher early CT-Belief interventions were found to predict significantly greater improvement. CT-Belief use did not predict greater symptom change among those without PD. Early focus on CT-Belief interventions may facilitate changes in depression and PD symptoms for patients with MDD-PD comorbidity.

Objectives: Reduced reward responsiveness, as measured by the event-related potential (ERP) component, the reward positivity (RewP), has been shown to play a role in the development of internalizing disorders, but implications for treatment remain unclear. In adult patients with anxiety and/or depression, reduced RewP has emerged as a predictor of greater change in symptoms following cognitive behavior therapy (CBT) or selective serotonin reuptake inhibitor (SSRI) treatment. The objectives of this preliminary study were to extend these findings to children and adolescents with anxiety disorders by evaluating RewP to reward as a predictor of change in anxiety severity or depressive symptoms following treatment with CBT or SSRI and to explore whether RewP differentially predicts response to one type of treatment. Methods: Patients (7-19 years old) with social and/or generalized anxiety disorder (N = 27) completed baseline measures of anxiety severity and depressive symptoms, as well as an ERP monetary reward anticipation and feedback task. RewP was measured in response to reward and breaking even feedback. Patients were then randomly assigned to CBT or SSRI treatment, and completed measures of anxiety and depressive symptom severity at the last treatment session. Results: Reduced reward responsiveness, as measured by RewP to rewards, predicted greater change in depressive symptoms following treatment, adjusting for baseline symptoms, age, and RewP to breaking even. RewP was not a significant predictor of change in anxiety symptoms. Although preliminary, exploratory analyses suggested that among anxious youth, RewP specifically predicted change in depressive symptoms following CBT, rather than SSRI. Conclusion: Results provide preliminary support for the utility of ERP measures of reward responsiveness in predicting treatment response in youth. With further research and standardization, ERP assessments could potentially be implemented in clinical settings to inform prognosis and treatment planning for youth with internalizing disorders.