PREDICTING THE SHORT-TERM OUTCOME OF FIRST EPISODES AND RECURRENCES OF CLINICAL DEPRESSION - A PROSPECTIVE-STUDY OF LIFE EVENTS, DIFFICULTIES, AND SOCIAL SUPPORT NETWORKS

Background: The study employed interview-based, investigator-rated mea sures of symptoms and psychosocial adversity in a panel survey to pred ict clinical course of depression. Method: 130 men and women attending psychiatric hospitals for episodes of depressive disorders were inter viewed with the Present State Examination and Life Events and Difficul ties Schedule. After a mean 4-month interval, 119 were successfully re assessed to test the hypothesis that recovery from clinical depression is related to rates of life event stress and difficulties (termed psy chosocial adversity) in the 6 to 12 months preceding initial evaluatio n. Results: The severity (p <.01) and the duration (p <.01) of the epi sode of depression up until the initial evaluation emerged as the only significant background predictors of episode severity at later follow -up. High levels of adversity were significantly (p <.05) related to a poor clinical course, due to failure to recover from first-onset and from second episodes. Recovery from all but first episodes was predict ed by higher levels of social support rated at initial attendance. The re was no evidence for the buffering of the harmful effects of adversi ty by larger, more connected social support networks. Conclusion: Both life event stress and support network characteristics are associated with the short-term outcome of depressive episodes. The findings for s ocial support in particular confirm growing evidence of the importance of distinguishing between early and later relapsing episodes in causa l investigations of depression. They reveal a progressive vulnerabilit y to deficits in social circumstances with advancing course of disorde r.