The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms
Abstract
BACKGROUND: Adverse life events and social support may influence the outcome of major depressive disorder (MDD). We hypothesized that outcome would depend on the level of depressive symptoms present at the outset, with those in partial remission being particularly vulnerable. METHOD: In the Vantaa Depression Study (VDS), patients with DSM-IV MDD were interviewed at baseline, and at 6 and 18 months. Life events were investigated with the Interview for Recent Life Events (IRLE) and social support with the Interview Measure of Social Relationships (IMSR) and the Perceived Social Support Scale - Revised (PSSS-R). The patients were divided into three subgroups at 6 months, those in full remission (n = 68), partial remission (n = 75) or major depressive episode (MDE) (n = 50). The influence of social support and negative life events during the next 12 months on the level of depressive symptoms, measured by the Hamilton Rating Scale for Depression (HAMD), was investigated at endpoint. RESULTS: The severity of life events and perceived social support influenced the outcome of depression overall, even after adjusting for baseline level of depression and neuroticism. In the full remission subgroup, both severity of life events and subjective social support significantly predicted outcome. However, in the partial remission group, only the severity of events, and in the MDE group, the level of social support were significant predictors. CONCLUSIONS: Adverse life events and/or poor perceived social support influence the medium-term outcome of all psychiatric patients with MDD. These factors appear to have the strongest predictive value in the subgroup of patients currently in full remission.
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Perceived social support has been shown to predict long-term outcome in different types of psychiatric illness, e.g. alcohol use disorders, major depressive disorder and bipolar disorder.
“Perceived social support has been shown to predict long-term outcome in different types of psychiatric illness, e.g. alcohol use disorders [34], major depressive disorder [35] and bipolar disorder [36].”
From Helpful and hindering factors for remission in dysthymia and panic disorder at 9-year follow-up: A mixed methods study (2008) · cites this paper as [35]
The risk and protective effects of perceived social support on depression have been widely studied.
“The risk7–10 and protective effects11–15 of percieved social support on depression have been widely studied.”
Depression predicts social support.
“Specifically, there is evidence that social support predicts depression and depression predicts social support.9,10,28,29”
There is evidence for bidirectional relationships between perceived social support and symptoms of anxiety and depression.
“Finally, there is some evidence for bidirectional relationships between perceived social support and symptoms of anxiety and depression.”
Social support predicts depression.
“Specifically, there is evidence that social support predicts depression and depression predicts social support.9,10,28,29”
Leskela et al. found that lower perceived social support six months after initial assessment predicted more severe depression at 18 months among all participants, though only significant in multivariable analysis for the remitted group.
“Leskela and colleagues [51] assessed adults with major depressive disorder and found that lower perceived social support six months after initial assessment predicted more severe depression at 18 months among all participants, although this relationship only remained significant in multivariable analysis for the group who had remitted following initial assessment (r = − 0.321).”
From Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review (2018) · cites this paper as [51]
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- Authors
- LESKELÄ, U., RYTSÄLÄ, H., KOMULAINEN, E., MELARTIN, T., SOKERO, P., LESTELÄ-MIELONEN, P., & ISOMETSÄ, E.
- Affiliations
- Helsinki University Hospital (FI)
- University of Helsinki (FI)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2006-03-28
- Volume
- 36
- Issue
- 6
- Pages
- 779-788
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W1998231988
- Cited by
- 105
- References
- 20
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 7 · 2023: 4 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 3 · 2018: 7 · 2017: 5 · 2016: 6 · 2015: 4 · 2014: 7 · 2013: 6 · 2012: 8
- FWCI
- 7.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- major depressive disorder, life events, perceived social support, depressive symptoms, remission, treatment outcomes, negative life events, neuroticism
- MeSH terms
- Adult, Attitude to Health, Depression, Major Depressive Disorder, Female, Follow-Up Studies, Humans, Interpersonal Relations, Interview, Psychological, Life Change Events, Male, Middle Aged, Periodicity, Surveys and Questionnaires, Remission Induction, Severity of Illness Index, Social Support, Diagnostic and Statistical Manual of Mental Disorders
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