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Predicting the Short-Term Outcome of First Episodes and Recurrences of Clinical Depression: A Prospective Study of Life Events, Difficulties, and Social Support Networks

J Clin Psychiatry 1997;58:298-306

Background: The study employed interview-based, investigator-rated measures of symptoms and psychosocial adversity in a panel survey to predict clinical course of depression.

Method: 130 men and women attending psychiatric hospitals for episodes of depressive disorders were interviewed with the Present State Examination and Life Events and Difficulties Schedule. After a mean 4-month interval, 119 were successfully reassessed to test the hypothesis that recovery from clinical depression is related to rates of life event stress and difficulties (termed psychosocial adversity) in the 6 to 12 months preceding initial evaluation.

Results: The severity (p<.01) and the duration (p<.01) of the episode of depression up until the initial evaluation emerged as the only significant background predictors of episode severity at later follow-up. High levels of adversity were significantly (p<.05) related to a poor clinical course, due to failure to recover from first-onset and from second episodes. Recovery from all but first episodes was predicted by higher levels of social support rated at initial attendance. There was no evidence for the buffering of the harmful effects of adversity by larger, more connected social support networks.

Conclusion: Both life event stress and support network characteristics are associated with the short-term outcome of depressive episodes. The findings for social support in particular confirm growing evidence of the importance of distinguishing between early and later relapsing episodes in causal investigations of depression. They reveal a progressive vulnerability to deficits in social circumstances with advancing course of disorder.