Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression
- 17 July 2009
- journal article
- research article
- Published by Cambridge University Press (CUP) in Psychological Medicine
- Vol. 40 (3), 415-424
- https://doi.org/10.1017/s0033291709990535
Abstract
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) (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]. 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.Keywords
This publication has 51 references indexed in Scilit:
- The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluationPsychological Medicine, 2004
- The Impact of Severe Negative Events in Marriage on DepressionJournal of Social and Clinical Psychology, 2001
- Marital adjustment and outcome following treatments for depression.Journal of Consulting and Clinical Psychology, 2001
- The London Depression Intervention TrialThe British Journal of Psychiatry, 2000
- Marital functioning and depressive symptoms: Evidence for a stress generation model.Journal of Personality and Social Psychology, 1997
- Intrainformant agreement and family functioning in depressed and nondepressed parents and their childrenThe American Journal of Family Therapy, 1992
- The impact of an uncaring partner on improvement in non-melancholic depressionJournal of Affective Disorders, 1992
- Generation of stress in the course of unipolar depression.Journal of Abnormal Psychology, 1991
- Marital therapy as a treatment for depression.Journal of Consulting and Clinical Psychology, 1991
- Generation of stress in the course of unipolar depression.Journal of Abnormal Psychology, 1991