Deterioration in psychosocial functioning predicts relapse/recurrence after cognitive therapy for depression

Background: Associations between major depressive disorder (MDD) and psychosocial functioning are incompletely understood across time and during continuation phase cognitive therapy (C-CT). We examined the validity of the Range of Impaired Functioning Tool (RIFT; [Leon, A.C., Solomon, D.A., Mueller, T.I., Turvey, C.L., Endicott, J., Keller, M.B., 1999. The Range of Impaired Functioning Tool (LIFE-RIFT): A brief measure of functional impairment. Psychol. Med. 29, 869-878.]) as a measure of psychosocial functioning and its relations to depressive symptoms in C-CT and assessment-only control conditions. Methods: Outpatients with recurrent MDD who responded to acute-phase cognitive therapy (A-CT) were randomized to 8 months of C-CT (n = 41) or assessment-only (n = 43) and followed 16 additional months [Jarrett, R.B., Kraft, D., Doyle, J., Foster, B.M., Eaves, G.G., Silver, P.C., 2001. Preventing recurrent depression using cognitive therapy with and without a continuation phase: A randomized clinical trial. Arch. Gen. Psychiatry 58, 381-388.]. Interviewers rated depressive symptoms and psychosocial functioning monthly. Patients completed additional self-reports. Results: The RIFT converged appropriately with other measures of psychosocial functioning, depressive symptoms, cognitive content, and personality. About half (55%) of patients were psychosocially "well" (RIFT ≤ 8) during the first month post-A-CT. C-CT improved psychosocial functioning only transiently compared to the assessment control. Examined prospectively, depressive symptom level did not predict monthly changes in psychosocial functioning significantly, whereas psychosocial dysfunction level predicted monthly changes in depressive symptoms and relapse/recurrence. Limitations: Findings may not generalize to other patient populations, treatments, and assessment methods. The cross-lagged correlational data structure allows only tentative conclusions about the causal effect of psychosocial functioning on depressive symptoms. Conclusions: The RIFT is a valid measure of psychosocial functioning among responders to A-CT for depression. After such response, deteriorations in psychosocial functioning may signal imminent major depressive relapse/recurrence and provide targets for change during treatments focused on relapse/recurrence prevention.