The Role of Positive Life Events on Treatment Outcome during Acute and Maintenance Interpersonal Psychotherapy for Recurrent Major Depressive Disorder
Major Depressive Disorder (MDD) is a highly recurrent and potentially chronic disorder. While much research has focused on the role of severe life events as important risk factors for depression onset, less is known about the relationship between positive life events and MDD. The purpose of the current study was to examine the relationship between positive life events and recovery from an acute episode of depression and maintenance of recovery in the context of Interpersonal Psychotherapy (IPT) treatment in women with recurrent MDD. One hundred thirty-one women who were enrolled in the Maintenance Psychotherapy in Recurrent Depression study (MH 49115 E. Frank, PI) entered into maintenance treatment and received at least one Life Events and Difficulties Schedule interview (LEDS; Brown & Harris, 1978). To simultaneously account for both positivity and threat, event ratings were divided into four mutually exclusive categories: provoking, severe, neutral, and positive. A Cox proportional hazards model with each of the four categories of life events included as time-dependent covariates was used to test the cumulative effects of life events on 1) time to remission during the acute treatment phase and 2) time to recurrence during the maintenance phase. Contrary to the hypotheses, there was no relationship between the cumulative experience of positive life events and remission from MDD during the acute treatment phase, nor was there a significant relationship between the cumulative experience of positive life events and episode recurrence. However, the cumulative experience of neutral life events was significantly related to episode recurrence, even when controlling for demographic and clinical variables, including personality pathology. This finding suggests that the cumulative effects of seemingly benign neutral events may disrupt therapy processes and trigger episode recurrence. Future work is needed to further elucidate the nature of these neutral life events and how they may be related to stress reactivity or stress generation in patients at high risk for MDD recurrence. This may help to clarify the mechanisms by which life events contribute to depression and how best to target these areas in therapy.
Advisor:Jill M. Cyranowski, Ph.D.; Ellen Frank, Ph.D.; Wesley Thompson, Ph.D.; Michael F. Pogue-Geile, Ph.D.; Thomas W. Kamarck, Ph.D.
School:University of Pittsburgh
School Location:USA - Pennsylvania
Source Type:Master's Thesis
Date of Publication:09/26/2007