Individuals with certain personality styles - those who are aggressive and those who have low dependency on other people - are at higher risk for recurrent bouts of major depression, according to a new University of Washington study.
The study comes from the laboratory of UW psychology professor Neil Jacobson, who found that people at risk for relapsing reported lower levels of satisfaction or pleasure from their activities than did people who remained well. The study also indicated that a patient's level of negative or dysfunctional thinking at the end of treatment was not predictive of relapse.
"Depression is a recurrent disease for a lot of people just like cancer," said Gollan, professor assistant, "People who receive cognitive behavioral psychotherapy for depression tend to feel less depressed when they complete it. However, other factors in their lives beyond their mood need to be identified if we are to help them stay well. We need to consider who people are and how they interact with others to understand how patients remain nondepressed."
Researchers are anxious to identify risk factors for recurrent depression because relapse rates among patients who respond to treatment are alarmingly high. Studies have shown that between 50 percent and 80 percent of patients successfully treated with cognitive behavioral therapy suffer a relapse, often within two years of remission. Cognitive behavioral therapy is the standard treatment for depression, often in conjunction with anti-depressant medication.
Depression is the most common mental health problem in the United States
In the new study, Gollan and Jacobson followed 78 patients who had recovered from major depression for two years to monitor changes. The patients all received 20 sessions of cognitive behavioral therapy for their depression and were considered symptom-free for at least two months before being accepted into the study. The researchers utilized a variety of interview questionnaires and self-report forms to measure depression, dysfunctional attitudes and pleasant activities at the beginning and end of treatment and every six months during the two-year follow-up. Personality styles were measured before and after treatment.
At the end of the study, 34 people, or 44 percent, had relapsed. Gollan said there seems to be different subsets of people who are at-risk for recurrent bouts of depression. One of those groups is made up of individuals who have a low dependency on other people. People with low dependency are usually independent people who may have little or no social support system, she said.
"Low dependency increases risk for relapse while moderate dependency encourages recovered patients to seek out social relationships that may function, over time, to reduce relapse risk," she said.
People who exhibited aggressive, hostile styles at the end of treatment also were more likely to relapse, "perhaps because they don't make good friends and turn off people," Gollan explained. "In their professional careers they have channeled aggression in productive, socially acceptable ways to their advantage and use people to their advantage. They also are pathologically independent and independence may be a risk factor if you have depression."
She added that clinicians working with depressed patients need to pay more attention to the enjoyment and satisfaction people get from activities rather than on the type and number of activities they engage in.
"We need to focus on how the activities feel," Gollan said. "We don't know why, but it is becoming clear that people are less at risk for relapse when they do things they enjoy rather than working on overcoming their negative thinking patterns. The treatment should be tailor-made to the depressed patient."
Other studies extend the personality factor influence on the potential development of the depressive disorder. It was found that people with the following types are in greater risk of developing depression than others:
- People with high levels of anxiety.
- Extremely shy people, when it is expressed in forms of “social avoidance” and “personal reserve”.
- People with high levels of self-criticism and low self-esteem.
- People with high interpersonal sensitivity.
- Perfectionists.
- People, who are extremely self-focused.
Researches show that people who fit the first four factors description are in substantially greater risk to depression, especially non-melancholic depression. Perfectionists are protected to certain degree from the depression, however, if the depressive disorder episodes occurs, they will be significantly longer than for non-perfectionists. Self-focused individuals are likely to be in greater risk for brief depressive episodes. While melancholic depression development was not found to be in any correlation with patients’ temperament or personality.
Another study reviewed the possible personality changes after depression is over, and concluded that personality traits of people who suffer a period of major depression remain unchanged.
"Our findings do not support the scar hypothesis," says Dr. M. Tracie Shea, associate professor of psychiatry and human behavior at Brown University , Providence , Rhode Island
In their report, Shea and her colleagues point to numerous studies in which people with a history of depression were characterized by having high levels of certain personality traits, including dependency on others, lack of social self-confidence, submissiveness, irritability, and social introversion.
"Our findings suggest these traits might represent a vulnerability to becoming depressed, rather than being an outcome of depression. Personality changes that might be present during an episode of major depression will resolve following full recovery -- they will not be lasting," she asserts.
