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Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression
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Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression
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Journal Article
Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression
2010
Overview
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.
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).
Patients with dyadic discord at baseline had lower remission rates (34.1%) than those without dyadic discord (61.2%) (all three treatment groups) (chi2=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].
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.
Publisher
Cambridge University Press
Subject
/ Adult
/ Aged
/ Antidepressive Agents, Second-Generation - therapeutic use
/ Behavior therapy. Cognitive therapy
/ Biological and medical sciences
/ Cognitive behavioral therapy
/ Cognitive Behavioral Therapy - methods
/ Cognitive-behavioral factors
/ Combined Modality Therapy - methods
/ Depressive Disorder, Major - drug therapy
/ Depressive Disorder, Major - psychology
/ Depressive Disorder, Major - therapy
/ Depressive personality disorders
/ Dyads
/ Female
/ Humans
/ Male
/ Marriage - statistics & numerical data
/ Measures
/ Patients
/ Pharmacology. Drug treatments
/ Psychiatric Status Rating Scales - statistics & numerical data
/ Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer
