Psychological Medicine

Original Articles

Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression

W. H. Dentona1 c1, T. J. Carmodya1a2, A. J. Rusha1a2, M. E. Thasea3, M. H. Trivedia1, B. A. Arnowa4, D. N. Kleina5 and M. B. Kellera6

a1 Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, TX, USA

a2 Department of Clinical Sciences, The University of Texas Southwestern Medical Center at Dallas, TX, USA

a3 Department of Psychiatry, University of Pennsylvania, PA, USA

a4 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA

a5 Department of Psychology, Stony Brook University, Stony Brook, NY, USA

a6 Department of Psychiatry and Human Behavior, Brown University, RI, USA


Background Dyadic discord, while common in depression, has not been specifically evaluated as an outcome predictor in chronic major depressive disorder. This study investigated pretreatment dyadic discord as a predictor of non-remission and its relationship to depressive symptom change during acute treatment for chronic depression.

Method Out-patients with chronic depression were randomized to 12 weeks of treatment with nefazodone, the Cognitive Behavioral Analysis System of Psychotherapy or their combination. Measures included the Marital Adjustment Scale (MAS) and the Inventory of Depressive Symptomatology – Self Report (IDS-SR30). Of 681 original patients, 316 were partnered and 171 of these completed a baseline and exit MAS, and at least one post-baseline IDS-SR30. MAS scores were analysed as continuous and categorical variables (‘dyadic discord’ v. ‘no dyadic discord’ defined as an MAS score >2.36. Remission was defined as an IDS-SR30 of 14 at exit (equivalent to a 17-item Hamilton Rating Scale for Depression of 7).

Results Patients with dyadic discord at baseline had lower remission rates (34.1%) than those without dyadic discord (61.2%) (all three treatment groups) (χ2=12.6, df=1, p=0.0004). MAS scores improved significantly with each of the treatments, although the change was reduced by controlling for improvement in depression. Depression remission at exit was associated with less dyadic discord at exit than non-remission for all three groups [for total sample, 1.8 v. 2.4, t(169)=7.3, p<0.0001].

Conclusions Dyadic discord in chronically depressed patients is predictive of a lower likelihood of remission of depression. Couple therapy for those with dyadic discord may increase remission rates.

(Received June 10 2008)

(Revised May 18 2009)

(Accepted May 23 2009)

(Online publication July 17 2009)


c1 Address for correspondence: W. H. Denton, M.D., Ph.D., University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9121, USA. (Email: