Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression

W. H. Denton, T. J. Carmody, A. J. Rush, M. E. Thase, M. H. Trivedi, B. A. Arnow, D. N. Klein, M. B. Keller

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background 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.Method 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).Results Patients with dyadic discord at baseline had lower remission rates (34.1%) than those without dyadic discord (61.2%) (all three treatment groups) ( 2=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].Conclusions 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.

Original languageEnglish (US)
Pages (from-to)415-424
Number of pages10
JournalPsychological Medicine
Volume40
Issue number3
DOIs
StatePublished - Mar 2010

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Social Adjustment
Depression
Therapeutics
Couples Therapy
Major Depressive Disorder
Psychotherapy
Self Report
Outpatients
Equipment and Supplies

Keywords

  • Chronic depression
  • Dyadic discord
  • Major depressive disorder
  • Predictors

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology

Cite this

Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression. / Denton, W. H.; Carmody, T. J.; Rush, A. J.; Thase, M. E.; Trivedi, M. H.; Arnow, B. A.; Klein, D. N.; Keller, M. B.

In: Psychological Medicine, Vol. 40, No. 3, 03.2010, p. 415-424.

Research output: Contribution to journalArticle

Denton, W. H. ; Carmody, T. J. ; Rush, A. J. ; Thase, M. E. ; Trivedi, M. H. ; Arnow, B. A. ; Klein, D. N. ; Keller, M. B. / Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression. In: Psychological Medicine. 2010 ; Vol. 40, No. 3. pp. 415-424.
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abstract = "Background 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.Method 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).Results Patients with dyadic discord at baseline had lower remission rates (34.1{\%}) than those without dyadic discord (61.2{\%}) (all three treatment groups) ( 2=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].Conclusions 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.",
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AU - Denton, W. H.

AU - Carmody, T. J.

AU - Rush, A. J.

AU - Thase, M. E.

AU - Trivedi, M. H.

AU - Arnow, B. A.

AU - Klein, D. N.

AU - Keller, M. B.

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N2 - Background 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.Method 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).Results Patients with dyadic discord at baseline had lower remission rates (34.1%) than those without dyadic discord (61.2%) (all three treatment groups) ( 2=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].Conclusions 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.

AB - Background 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.Method 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).Results Patients with dyadic discord at baseline had lower remission rates (34.1%) than those without dyadic discord (61.2%) (all three treatment groups) ( 2=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].Conclusions 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.

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KW - Major depressive disorder

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