The development of major depressive episodes during the course of dysthymic and episodic major depressive disorders: a retrospective examination of life events

Background: The present study examined whether stressful life events are as sociated with the development of major depressive episodes (MDEs) in a long itudinal, retrospective study of dysthymic and episodic major depressive di sorders. Methods: Sixty-seven outpatients with DSM-III-R dysthymia and 38 o utpatients with non-chronic major depression were followed up 30-60 months after entry into the study. Follow-up assessments included a modified versi on of Paykel's (1997) Interview for Recent Life Events (IRLE) and Keller et al.'s (1987) Longitudinal Interval Follow-up Evaluation. Life events were assessed retrospectively in the 6 months before the most recent MDE or in t he 6 months before follow-up for patients without a MDE. Results: In dysthy mic patients, MDEs were significantly associated with a new life event in t he context of an ongoing chronic stressor. In episodic major depressive pat ients, relapses were associated with new life events regardless of an ongoi ng chronic stressor Limitations This was retrospective study. It was also a conservative test of the association between life events and MDEs as the f ollow-up period over which life events were assessed was long, increasing t he possibility of forgetting; events occurring less than 1 month before rel apse were excluded to avoid confounding the event with the MDE; life events were assessed for a more distant time period for patients who experienced MDEs than those who did not; and an abbreviated version of the IRLE was use d which may have failed to identify less severe events. Conclusions: This s tudy suggests that life events may play a role in the onset of MDEs in pers ons with dysthymic disorder and those with major depressive disorder. Thus, clinicians should monitor dysthymic patients after a stressful life event, particularly if it occurs in the context of a chronic, ongoing stressor. ( C) 2000 Elsevier Science B.V. All rights reserved.