Psychological Medicine



Original Article

The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms


ULLA LESKELÄ a1a2, HEIKKI RYTSÄLÄ a1a2, ERKKI KOMULAINEN a4, TARJA MELARTIN a1a3, PETTERI SOKERO a1a3, PAULA LESTELÄ-MIELONEN a1a2 and ERKKI ISOMETSÄ a1a3c1
a1 Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland
a2 Department of Psychiatry, HUCH, Peijas Hospital, Health Care District of Helsinki and Uusimaa, Vantaa, Finland
a3 Department of Psychiatry, HUCH, Helsinki, Health Care District of Helsinki and Uusimaa, Finland
a4 Department of Education, Faculty of Behavioural Sciences, University of Helsinki, Finland

Article author query
leskela u   [PubMed][Google Scholar] 
rytsala h   [PubMed][Google Scholar] 
komulainen e   [PubMed][Google Scholar] 
melartin t   [PubMed][Google Scholar] 
sokero p   [PubMed][Google Scholar] 
lestela-mielonen p   [PubMed][Google Scholar] 
isometsa e   [PubMed][Google Scholar] 

Abstract

Background. Adverse life events and social support may influence the outcome of major depressive disorder (MDD). We hypothesized that outcome would depend on the level of depressive symptoms present at the outset, with those in partial remission being particularly vulnerable.

Method. In the Vantaa Depression Study (VDS), patients with DSM-IV MDD were interviewed at baseline, and at 6 and 18 months. Life events were investigated with the Interview for Recent Life Events (IRLE) and social support with the Interview Measure of Social Relationships (IMSR) and the Perceived Social Support Scale – Revised (PSSS-R). The patients were divided into three subgroups at 6 months, those in full remission (n=68), partial remission (n=75) or major depressive episode (MDE) (n=50). The influence of social support and negative life events during the next 12 months on the level of depressive symptoms, measured by the Hamilton Rating Scale for Depression (HAMD), was investigated at endpoint.

Results. The severity of life events and perceived social support influenced the outcome of depression overall, even after adjusting for baseline level of depression and neuroticism. In the full remission subgroup, both severity of life events and subjective social support significantly predicted outcome. However, in the partial remission group, only the severity of events, and in the MDE group, the level of social support were significant predictors.

Conclusions. Adverse life events and/or poor perceived social support influence the medium-term outcome of all psychiatric patients with MDD. These factors appear to have the strongest predictive value in the subgroup of patients currently in full remission.


Correspondence:
c1 Department of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland. (Email: erkki.isometsa@ktl.fi)


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