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Longitudinal Effects of Personality Disorders on Psychosocial Functioning of Patients With Major Depressive Disorder

J Clin Psychiatry 2007;68(2):186-193

Objective: No previous research has focused on psychosocial functioning in understanding how personality disorders compound the impairment caused by major depressive disorder over time. This report describes the effects of persistent and remitting comorbid personality disorders on the depressive status and functioning of patients with major depressive disorder over the course of 2 years.

Method: Longitudinal data on functioning from the first 2 years of the Collaborative Longitudinal Personality Disorders Study were evaluated for 3 groups of subjects with major depressive disorder: subjects with major depressive disorder alone (N = 103), those with persistent comorbid personality disorders (N = 164), and those with comorbid personality disorders that remitted (N = 69). DSM-IV criteria were used for mood and personality disorder diagnoses. The data were gathered from September 1996 to August 2000 and from September 2001 to September 2004.

Results: Subjects whose personality disorders remitted were more likely than those with persisting personality disorders to have major depressive disorder remit. Social functioning, as measured by the Longitudinal Interval Follow-up Evaluation and the Global Assessment of Functioning, improved across a range of domains over time, with most gains occurring in the first 6 months of follow-up and with differential improvement by group. As hypothesized, subjects whose personality disorders remitted fared nearly as well as did subjects without personality disorders, whereas subjects whose personality disorders persisted functioned most poorly.

Conclusions: Outcome research on major depressive disorder has often ignored Axis II disorders. Our data indicate that the longitudinal course of personality psychopathology meaningfullyinfluences depressive outcome and psychosocial functioning in patients with major depressive disorder. The findings indicate the need to target both symptom relief and psychosocial functioning and to treat both personality and mood disorders in comorbid patients.