Of the 1,996 respondents diagnosed with major depressive disorder at Wave 1, 302 (15.1%) (SE=1.0) had persistent disorder at Wave 2, meeting full criteria for major depressive disorder throughout the entire three-year follow-up, without mania or hypomania. One hundred and forty-five (145) of the 1,996 (7.3%) (SE=0.7) who had major depressive disorder at Wave 1 and remitted had a subsequent recurrence.
Of the demographic variables, only gender predicted major depressive disorder persistence or recurrence. Males were less likely than females to have an episode persist (odds ratio=0.66, 95% CI=0.45–0.97) or recur (odds ratio= 0.55, 95% CI=0.33–0.91) by Wave 2. Among Axis I disorders, dysthymic disorder (odds ratio=1.79, 95% CI=1.23–2.60), any anxiety disorder (odds ratio=1.96, 95% CI=1.43–2.68), specific phobia (odds ratio=2.19, 95% CI=1.53–3.12), and panic disorder (odds ratio=2.18, 95% CI=1.30–3.68) all predicted persistence. After additionally controlling for other Axis I disorders, dysthymic disorder (odds ratio=1.75, 95% CI=1.20–2.54), specific phobia (odds ratio=2.08, 95% CI=1.46–2.99), and panic disorder (odds ratio=1.87, 95% CI=1.11–3.15) remained significant predictors of persistence. No co-morbid Axis I disorder predicted recurrence.
shows the percent of participants who had persistent major depressive disorder by each of the 10 personality disorders and no personality disorder. Among participants with a personality disorder, those with borderline had the highest percent of persistence (28.9%, SE=2.75) and those with narcissistic had the lowest (14.6%, SE=2.52). Several personality disorders predicted major depressive disorder persistence in univariate analyses, including avoidant (odds ratio=1.97, 95% CI=1.25–3.10), borderline (odds ratio=3.23, 95% CI=2.34–4.49), histrionic (odds ratio=2.20, 95% CI=1.14–4.24), paranoid (odds ratio=1.80, 95% CI=1.21–2.68), schizoid (odds ratio=2.46, 95% CI=1.54–3.95), and schizotypal (odds ratio=2.23, 95% CI=1.37–3.65) personality disorders. No personality disorder predicted recurrence.
Percent of MDD Persistence by Personality Disorder Status, among those who had MDD at W1 (N=1,996)
No family history variable predicted persistence, but a family history of depression predicted recurrence (odds ratio=1.72, 95% CI=1.11–2.67). History of treatment for major depressive disorder predicted persistence (odds ratio=2.07, 95% CI=1.48–2.89), but not recurrence. Among other clinical features of major depressive disorder, earlier age at onset (odds ratio= 0.97, 95% CI=0.96–0.99) and number of previous episodes (odds ratio=1.02, 95% CI=1.01–1.03) weakly predicted persistence, while duration of most recent episode did not. No clinical feature significantly predicted recurrence.
presents the population attributable risk proportions for the effects of co-occurring psychopathology and related risk factors on the persistence of major depressive disorder. Those disorders with the highest values included borderline (57.3%), schizoid (47.9%), and schizotypal (45.3%) personality disorders; and any anxiety disorder (43.4%).
displays the results of the multivariate analyses testing the associations of personality disorders with major depressive disorder persistence. In Model 1, with demographic factors controlled, avoidant, borderline, histrionic, paranoid, schizoid, and schizotypal personality disorders all remained significant predictors. In Model 2, with additional controls for Axis I disorder co-morbidity, avoidant, borderline, paranoid, schizoid, and schizotypal personality disorders remained significant. In Model 3, with all personality disorders added simultaneously to the model, only borderline and schizoid remain significant. The addition of family history of psychiatric and substance use disorders (Model 4) resulted in virtually no change in the results. When a history of treatment, age at first onset, number of previous episodes, and duration of current episode at Wave 1 were added (Model 5), borderline personality disorder remained a robust predictor of major depressive disorder persistence (odds ratio=2.51, 95% CI=1.67–3.77).