Abstract
Aim of the study was to identify patient variables that predict specific patterns of symptom course during and after hospital treatment for major depressive disorder (MDD). In a sample of 518 patients, four pairs of clinically relevant patterns of symptom change were contrasted. The time points of measurement were admission, discharge, 3 and 12 month after discharge. CATREG was used to identify the best sets of predictors from 28 variables. A greater reduction in self-criticism during hospital treatment was the strongest predictor of rapid and sustained improvement. Traumatic childhood experiences and lower abilities for communication with others predicted a transient relapse after discharge, while a co-morbid personality disorder and higher level of anxiety differentiated between those with a persistent relapse and those with only a transient relapse in depressive symptoms following discharge. Overall, patients with less severe depression at admission, better abilities in self-perception, and less self-criticism (baseline and/or greater reduction during treatment) showed a better outcome after 1 year. There is limited generalizability to other countries and treatment settings. Data on personality functioning were not available for all patients and findings are correlational in nature. However, findings are in support of a psychotherapeutic focus on a reduction of self-criticism in MDD. Patient with traumatization, a co-morbid personality disorder and lower abilities to communicate their emotional needs should get specific attention and support after discharge from hospital treatment.
Highlights
Major depressive disorder (MDD) shows a broad variability in symptom courses, with a considerable percentage of patients experiencing relapses or recurrences after symptom free periods [1, 2]
A main finding of the study was that change in self-criticism emerged as the most relevant predictor for a lower risk for relapse and a positive 1 year outcome in MDD in a group of severely disturbed patients that were in need of hospital treatment
Self-criticism is seen at the core of psychopathology in MDD regardless of the theoretical orientation [25, 26], and seems to be a relevant phenomenon in other mental disorders [27]
Summary
Major depressive disorder (MDD) shows a broad variability in symptom courses, with a considerable percentage of patients experiencing relapses or recurrences after symptom free periods [1, 2]. To identify patient variables that are predictive of different patterns of symptom course is of clinical importance [3]. Seven distinguishable patterns of symptom change were found empirically and shown in Figure 1 [8], which replicated the categories remission, relapse and recurrence as described by Kupfer [9], and additional courses with clinically meaningful trajectories. These included a subgroup of patients with a persistent but comparatively slow improvement of symptoms and subgroups of patients with a temporary or prolonged relapse after discharge from hospital [8]
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