Positive and negative life events and personality traits in predicting course of depression and anxiety.

To examine the prognostic value of personality dimensions and negative and positive life events for diagnostic and symptom course trajectories in depressive and anxiety disorder. A total of 1209 subjects (18-65 years) with depressive and/or anxiety disorder were recruited in primary and specialized mental health care. Personality dimensions at baseline were assessed with the NEO-FFI and incidence and date of life events retrospectively with a structured interview at 2-year follow-up. DSM-IV-based diagnostic interviews as well as life chart assessments allowed course assessment at both the diagnostic and symptom trajectory level over 2 years. Life events were significantly related to diagnostic and symptom course trajectories of depression and anxiety also after correcting for sociodemographic and clinical characteristics. Only negative life events prospectively predicted longer time to remission of depressive disorder. Prospective associations of neuroticism and extraversion with prognosis of anxiety and depression were greatly reduced after correcting for baseline severity and duration of index disorder. Personality traits did not moderate the effect of life events on 2-year course indicators. Negative life events have an independent effect on diagnostic and symptom course trajectories of depression and to a lesser extent anxiety unconfounded by sociodemographic, clinical, and personality characteristics.

Spinhoven P ，Elzinga BM ，Hovens JG ，Roelofs K ，van Oppen P ，Zitman FG ，Penninx BW ... -  《-》

Two-year course of depressive and anxiety disorders: results from the Netherlands Study of Depression and Anxiety (NESDA).

Whether course trajectories of depressive and anxiety disorders are different, remains an important question for clinical practice and informs future psychiatric nosology. This longitudinal study compares depressive and anxiety disorders in terms of diagnostic and symptom course trajectories, and examines clinical prognostic factors. Data are from 1209 depressive and/or anxiety patients residing in primary and specialized care settings, participating in the Netherlands Study of Depression and Anxiety. Diagnostic and Life Chart Interviews provided 2-year course information. Course was more favorable for pure depression (n=267, median episode duration = 6 months, 24.5% chronic) than for pure anxiety (n=487, median duration = 16 months, 41.9% chronic). Worst course was observed in the comorbid depression-anxiety group (n=455, median duration > 24 months, 56.8% chronic). Independent predictors of poor diagnostic and symptom trajectory outcomes were severity and duration of index episode, comorbid depression-anxiety, earlier onset age and older age. With only these factors a reasonable discriminative ability (C-statistic 0.72-0.77) was reached in predicting 2-year prognosis. Depression and anxiety cases concern prevalent - not incident - cases. This, however, reflects the actual patient population in primary and specialized care settings. Their differential course trajectory justifies separate consideration of pure depression, pure anxiety and comorbid anxiety-depression in clinical practice and psychiatric nosology.

Penninx BW ，Nolen WA ，Lamers F ，Zitman FG ，Smit JH ，Spinhoven P ，Cuijpers P ，de Jong PJ ，van Marwijk HW ，van der Meer K ，Verhaak P ，Laurant MG ，de Graaf R ，Hoogendijk WJ ，van der Wee N ，Ormel J ，van Dyck R ，Beekman AT ... -  《-》

The effects of neuroticism, extraversion, and positive and negative life events on a one-year course of depressive symptoms in euthymic previously depressed patients versus healthy controls.

Spinhoven P ，Elzinga B ，Roelofs K ，Hovens JG ，van Oppen P ，Zitman FG ，Penninx BW ... -  《-》

Categorical and dimensional stability of comorbid personality disorder symptoms in DSM-IV major depressive disorder: a prospective study.

To investigate the categorical and dimensional temporal stability of Axis II personality disorders among depressive patients, and to determine whether variations in Axis I comorbid disorders or self-reported personality traits predict changes in researcher-assigned personality disorder symptoms. Patients with DSM-IV major depressive disorder (MDD) in the Vantaa Depression Study (N = 269) were interviewed with the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry, version 2.0, and the Structured Clinical Interview for DSM-III-R Axis II Disorders and were assessed with the 57-item Eysenck Personality Inventory at baseline, 6 months, and 18 months. Baseline interviews occurred between February 1, 1997, and May 31, 1998; follow-up interviews were 6 months and 18 months after baseline for each patient. Of the patients included in the study, 193 remained unipolar and could be interviewed at both follow-ups. The covariation of the severity of depression, anxiety, alcohol use, and reported neuroticism and extraversion with assigned personality disorder symptoms was investigated by using general estimation equations. The diagnosis of personality disorder persisted at all time points in about half (43%) of the 81 MDD patients diagnosed with personality disorder at baseline. The number of positive personality disorder criteria declined, particularly during the first 6 months, by a mean of 3 criteria. The decline in reported personality disorder symptoms covaried significantly with declines in the severity of depressive and anxiety symptoms (depressive: P = .02 for paranoid, P = .02 for borderline, and P = .01 for avoidant; anxiety: P = .08 for paranoid, P = .01 for borderline, and P < .001 for avoidant). Changes in patients' perceptions of self as measured by neuroticism covaried with changes in paranoid (P = .01) and borderline (P < .001) personality disorder symptoms. Among MDD patients, the categorical stability of concurrent personality disorder diagnoses assigned while depressed is relatively poor, but the dimensional stability is moderate. The remission of depression as well as variations in Axis I comorbidity, particularly anxiety disorders, influences personality disorder diagnoses. These diagnostic difficulties most likely reflect broader variations in patients' perceptions of self over time, not merely psychometric problems related to the pertinent diagnostic criteria.

Melartin TK ，Haukka J ，Rytsälä HJ ，Jylhä PJ ，Isometsä ET ... -  《-》

Impact of childhood life events and trauma on the course of depressive and anxiety disorders.

Data on the impact of childhood life events and childhood trauma on the clinical course of depressive and anxiety disorders are limited. Longitudinal data were collected from 1209 adult participants in the Netherlands Study of Depression and Anxiety (NESDA). Childhood life events and trauma at baseline were assessed with a semi-structured interview and the clinical course after 2 years with a DSM-IV-based diagnostic interview and Life Chart Interview. At baseline, 18.4% reported at least one childhood life event and 57.8% any childhood trauma. Childhood life events were not predictive of any measures of course trajectory. Emotional neglect, psychological and physical abuse, but not sexual abuse, were associated with persistence of both depressive and comorbid anxiety and depressive disorder at follow-up. Emotional neglect and psychological abuse were associated with a higher occurrence of a chronic course. Poor course outcomes were mediated mainly through a higher baseline severity of depressive symptoms. Childhood trauma, but not childhood life events, was associated with an increased persistence of comorbidity and chronicity in adults with anxiety and/or depressive disorders. More unfavourable clinical characteristics at baseline mediate the relationship between childhood trauma and a poorer course of depressive and anxiety disorders.

Hovens JG ，Giltay EJ ，Wiersma JE ，Spinhoven P ，Penninx BW ，Zitman FG ... -  《-》