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Fragile States of Mind: Neuroticism, Vulnerability and the Long-Term Outcome of Depression

Published online by Cambridge University Press:  02 January 2018

P. G. Surtees  and
N. W. J. Wainwright
P. G. Surtees*
Affiliation:
MRC Biostatistics Unit
N. W. J. Wainwright
Affiliation:
MRC Biostatistics Unit
*
Dr P. G. Surtees, MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR
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Abstract

Background

This paper considers the extent to which vulnerability to the outcome of major affective disorder is conferred through personality deviance. Results are based upon a 12 year longitudinal follow-up study of 80 patients with a primary depressive disorder, originally selected from a consecutive series seeking care at a hospital in Scotland.

Methods

The study included detailed clinical course assessments in association with the formal application of diagnostic criteria. Assessments on recovery from the index episode included measures of self-confidence and of neuroticism. Experience of selected severe loss events over the study period was also determined.

Results

Limited self-confidence was strongly related, unlike neuroticism, to the subsequent first recurrence of affective disorder. Relationships between psychosocial, clinical and demographic factors and long-term outcome revealed psychosocial factors, in particular neuroticism and a lack of self-confidence, to have the greatest prognostic significance.

Conclusions

These results reveal the heightened risk over the long-term of a poor outcome for depressive disorder consequent upon measures of personality deviance and of exposure to adversity. While giving only limited support to narrowly defined psychosocial models of depression, they clarify the risk gradients involved and through this may provide a firmer basis than hitherto for relapse prevention.

Type
Papers
Information
The British Journal of Psychiatry , Volume 169 , Issue 3 , September 1996 , pp. 338 - 347
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

Andrews, G., Neilson, M., Hunt, C., et al (1990) Diagnosis, personality and the long-term outcome of depression. British Journal of Psychiatry, 157, 13–18.CrossRefGoogle ScholarPubMed
Andrews, G. & Brown, G. W. (1995) Stability and change in low self-esteem: the role of psychosocial factors. Psychological Medicine, 25, 23–31.CrossRefGoogle ScholarPubMed
Bedford, A. & Foulds, G. (1978) Personality Deviance Scales. (Manual). Windsor. National Foundation for Educational Research.Google Scholar
Bouchard, T. J. (1994) Genes, environment, and personality. Science, 264, 1700–1701.Google Scholar
Brown, G. W., Andrews, B., Harris, T., et al (1986) Social support, self-esteem and depression. Psychological Medicine, 16, 813–831.CrossRefGoogle ScholarPubMed
Brown, G. W., Bifulco, A. & Harris, T. O. (1987) Life events, vulnerability and onset of depression: some refinements. British Journal of Psychiatry, 161, 44–54.CrossRefGoogle Scholar
Brown, G. W., Andrews, B., Bifulco, A., et al (1990) Self-esteem and depression. 1. Measurement issues and prediction of onset. Social Psychiatry and Psychiatric Epidemiology, 25, 200–209.Google Scholar
Brown, G. W., Lemyre, L. & Bifulco, A. (1992) Social factors and recovery from anxiety and depressive disorders. A test of specificity. British Journal of Psychiatry, 161, 44–54.Google Scholar
Brown, G. W., Harris, T. O. & Hepworth, C. (1995) Loss, humiliation and entrapment among women developing depression: a patient and non-patient comparison. Psychological Medicine, 25, 7–21.Google Scholar
Caine, T. M., Foulds, G. A. & Hope, K. (1967) Manual of the Hostility-Direction of Hostility Questionnaire (HDHQ). London: University of London Press.Google Scholar
Chambers, J. M. & Hastie, T. J. (1992) Statistical Models in S. Pacific Grove. Wadsworth & Brooks-Cole.Google Scholar
Deary, I. J., Bedford, A. & Fowkes, F. G. R. (1995) The Personality Deviance Scales: their development, associations, factor structure and restructuring. Personality and Individual Differences, 19, 275–291.Google Scholar
Duggan, C. F., Lee, A. S. & Murray, R. M. (1990) Does personality predict long-term outcome in depression? British Journal of Psychiatry, 157, 19–24.Google Scholar
Duggan, C. F., Lee, A. S. & Murray, R. M. (1991a) Do different subtypes of hospitalized depressives have different long-term outcomes? Archives of General Psychiatry, 48, 308–312.Google Scholar
Duggan, C. F., Sham, P., Lee, A. S., et al (1991b) Does recurrent depression lead to a change in neuroticism? Psychological Medicine, 21, 985–990.CrossRefGoogle ScholarPubMed
Endicott, J., Spitzer, R. L., Fleiss, J. L., et al (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766–771.Google Scholar
Eysenck, H. J. & Eysenck, S. B. G. (1964) Manual of the Eysenck Personality Inventory. London: University of London Press.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–61.Google Scholar
Hand, D. J. (1994) Deconstructing statistical questions. Journal of the Royal Statistical Society A, 157, 317–356.CrossRefGoogle Scholar
Hirschfeld, R. M. A., Klerman, G. L., Andreasen, N. C., et al (1986) Psychosocial predictors of chronicity in depressed patients. British Journal of Psychiatry, 148, 648–654.Google Scholar
Hopper, J. L. (1993) Variance components for statistical genetics: applications in medical research to characteristics related to human diseases and health. Statistical Methods in Medical Research, 2, 199–223.Google Scholar
Ingham, J. G., Kreitman, N. B., Miller, P. McC., et al (1986) Self-esteem, vulnerability and psychiatric disorder in the community. British Journal of Psychiatry, 148, 375–385.CrossRefGoogle ScholarPubMed
Ingham, J. G., Kreitman, N. B., Miller, P. McC., et al (1987) Self-appraisal, anxiety and depression in women. A prospective enquiry. British Journal of Psychiatry, 151, 643–651.Google Scholar
Jablensky, A. (1987) Prediction of the course and outcome of depression. Psychological Medicine, 17, 1–9.Google Scholar
Keller, M. B., Lavori, P. W., Friedman, B., et al (1987) The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540–548.Google Scholar
Kendell, R. E. (1982) The choice of diagnostic criteria for biological research. Archives of General Psychiatry, 39, 1334–1339.Google Scholar
Kendler, K. S. (1995) Adversity, stress and psychopathology – a psychiatric genetic perspective. International Journal of Methods in Psychiatric Research, 5, 163–170.Google Scholar
Kendler, K. S., Neale, M. C., Kessler, R. C., et al (1993a) A longitudinal twin study of personality and major depression in women. Archives of General Psychiatry, 50, 853–862.CrossRefGoogle ScholarPubMed
Kendler, K. S., Kessler, R. C., Neale, M. C., et al (1993b) The prediction of major depression in women: toward an integrated etiologic model. American Journal of Psychiatry, 150, 1139–1148.Google ScholarPubMed
Kerr, T. A., Roth, M. & Schapira, K. (1974) Prediction of outcome in anxiety states and depressive illnesses. British Journal of Psychiatry, 124, 125–133.Google Scholar
Kiloh, L. G., Andrews, G. & Neilson, M. (1988) The long-term outcome of depressive illness. British Journal of Psychiatry, 153, 752–757.Google Scholar
Lee, A. S. & Murray, R. M. (1988) The long-term outcome of Maudsley depressives. British Journal of Psychiatry, 153, 741–751.CrossRefGoogle ScholarPubMed
Plomin, R., Pedersen, N. L., Lichtenstein, P., et al (1990) Genetic influence on life events during the last half of the life span. Psychology and Aging, 5, 25–30.CrossRefGoogle ScholarPubMed
Plomin, R., Owen, M. J. & McGuffin, P. (1994) The genetic basis of complex human behaviours. Science, 264, 1733–1739.CrossRefGoogle Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry, 35, 773–782.CrossRefGoogle ScholarPubMed
Surtees, P. G. (1995) In the shadow of adversity: the evolution and resolution of anxiety and depressive disorder. British Journal of Psychiatry, 166, 583–594.CrossRefGoogle ScholarPubMed
Surtees, P. G. & Barkley, C. (1994) Future imperfect; the long-term outcome of depression. British Journal of Psychiatry, 164, 327–341.CrossRefGoogle ScholarPubMed
Weissman, M. M., Prusoff, B. A. & Klerman, G. L. (1978) Personality and the prediction of long-term outcome of depression. American Journal of Psychiatry, 135, 797–800.Google Scholar
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