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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 [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]
In the citing paper
“The risk7–10 and protective effects11–15 of percieved social support on depression have been widely studied.”
In the citing paper
“Specifically, there is evidence that social support predicts depression and depression predicts social support.9,10,28,29”
In the citing paper
“Finally, there is some evidence for bidirectional relationships between perceived social support and symptoms of anxiety and depression.”
In the citing paper
“Specifically, there is evidence that social support predicts depression and depression predicts social support.9,10,28,29”
In the citing paper
“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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“Many psychological studies provide evidence that even the mere perceived availability of social support can have a direct beneficial effect on health and mood (Cobb, 1976; Cohen & Hoberman, 1983; Cohen & Wills, 1985; Leskelä et al., 2006; Nasser & Overholser, 2005; Nezlek & Allen, 2006; Paykel, Emms, Fletcher, & Rassa…”
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Adolescent Depression: Stress and Reward Dysfunction
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Predictors of Early Postoperative Quality of Life after Elective Resection for Colorectal Cancer
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“Psychosocial stressors Ongoing psychosocial stressors might influence the outcome of treatment of MDD (Brown et al., 2010; Leskela et al., 2006).”
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“More research is needed to fully understand this network of relationships, as well as to identify other facets of religiousness that may impact mental health, and potential mechanisms to account for the residual relationships not explained by stress and social support.”
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“Furthermore, it is well known that social support provides a buffer for depression (27), although it is perhaps insufficiently recognized that social supports also reduce Ehnvall et al.”
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“Leskelä et al.(16) verified that both adverse life events and poor perceived social support predicted the outcome of subjects with major depression.”
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“In addition, there are some indications that access to social support is associated with less treatment use [27, 45] and being able to reach remission without professional help [26, 46, 47].”
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InfluentialReduced autobiographical memory specificity affects general distress through poor social support
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“Furthermore, it is well known that social support provides a buffer for depression (41), although it is perhaps insufficiently recognized that social support also reduces the perception of pain (42).”
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“Moreover, previous studies have revealed that the impact of SLEs on suicide varied by gender and the level of depressive symptoms;[19,32] thus, a rigorous test was performed to test the relationship between SLEs and suicide in patients with MDD by adjusting for gender, age, marriage, drinking, having no child, and dep…”
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“, 1969) or as predictors for the outcome of depression (Leskela et al., 2006; Melartin et al., 2004; Monroe and Depue, 1991; Moos et al., 1998) and disability (Rytsala et al.”
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“life events have been associated with higher level of depressive symptoms at follow-up (Leskelä et al., 2006).”
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Wilson, S., & Olino, T. M. (2021) · Journal of Personality · doi:10.1111/jopy.12623 · Cited by 40
Interventions in Chinese Undergraduate Students’ Mental Health: Systematic Review
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Central Role of the Brain in Stress and Adaptation
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“Lack of social support can be a risk factor for developing depressive symptoms in late life [15], and both adverse life events and poor perceived social support predict long-term major depressive disorder [36].”
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“They have been associated with stressful life events, such as the death of a close relative (spouse or child), divorce, severe illness or injury, job loss or major financial problems (Kessler 1997), and with social isolation or poor social support (Leskela et al. 2006).”
BackgroundDo stressful life events predict medical treatment outcome in first episode of depression?
Bock, C., Bukh, J. D., Vinberg, M., Gether, U., & Kessing, L. V. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0491-1 · Cited by 27
“The overlap in relation to response to treatment is illustrated by the findings that some studies suggest that poor responders experience a significant higher number of life events during follow up time compared to good responders [4, 8, 13, 20 , 21, 31, 37].”
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Religious and Spiritual Factors in Depression
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Factors predicting the long-term illness course in a cohort of depressed inpatients
Kuehner, C., & Huffziger, S. (2012) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-012-0379-7 · Cited by 25
“Positive social support has been found to facilitate recovery from major depression [15, 24, 44], and social support deficits predicted more depressive symptoms and longer episode duration in clinically depressed patients [16, 37, 47].”
BackgroundResultLeskelä, U. S., Melartin, T. K., Rytsälä, H. J., Jylhä, P. J., Sokero, P., Lestelä-Mielonen, P. S., & Isometsä, E. T. (2009) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181b97960 · Cited by 25
“Adversities and subjective social support influenced significantly and negatively the 18-month outcome of patients with MDD (Leskela et al., 2006), and persistence of MDD was significantly related to worse objective and subjective social support (Leskela et al.”
BackgroundAssociation of AGTR1 With 18-Month Treatment Outcome in Late-Life Depression
Kondo, D. G., Speer, M. C., Krishnan, K., McQuoid, D. R., Slifer, S. H., Pieper, C. F., Billups, A. V., & Steffens, D. C. (2007) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e31805470a4 · Cited by 19
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“Similarly, among the interpersonal relationship factors that are predictive of a response to antidepressant drugs, social support also stands out in the external field of clinical care (32), given that scarce social support is a risk factor in both the etiology and recurrence of depressive episodes and also in the res…”
BackgroundMitchell, C. S., Campbell, E. J., Fisher, S. D., Stanton, L. M., Burton, N. J., Pearl, A. J., McNally, G. P., Bains, J. S., Füzesi, T., Graham, B. A., et al. (2024) · Translational Psychiatry · doi:10.1038/s41398-023-02710-0 · Cited by 19
“No obvious tissue damage was observed during cFos processing of brain slices, however additional immunohistochemical markers sensitive to cell death should be considered for future experiments.”
BackgroundRate and Predictors of Persistent Major Depressive Disorder in a Nationally Representative Sample
Walker, E. R., & Druss, B. G. (2014) · Community Mental Health Journal · doi:10.1007/s10597-014-9793-9 · Cited by 19
“…a longitudinal study design with follow-up periods ranging from 3 months (e.g., Meyers et al. 2002; Nasser and Overholser 2005) to 1–2 years (Leskela et al. 2006; Melartin et al. 2004; Szadoczky et al. 2004; Zlotnick et al. 1996) to 15 years in the case of the National Institutes of Mental…”
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“alcohol use disorders [34], major depressive disorder [35] and bipolar disorder [36].”
BackgroundStrandholm, T., Kiviruusu, O. H., Karlsson, L., Pankakoski, M., Pelkonen, M. U. I., & MARTTUNEN, M. J. (2016) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000623 · Cited by 15
“In our study, change in social support did not associate with change in PD symptoms during follow-up, results in line with the view that perceived social support reflect more stable characteristics of personality (Leskelä et al., 2006).”
BackgroundResultPain and rejection sensitivity in bipolar depression
Ehnvall, A., Mitchell, P. B., Hadži-Pavlović, D., Loo, C. K. A., Breakspear, M. J., Wright, A., Roberts, G. M. P., Frankland, A., & Corry, J. (2011) · Bipolar Disorders · doi:10.1111/j.1399-5618.2011.00892.x · Cited by 15
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Vidal, C., Silverman, J. R., Petrillo, E. K., & Lilly, F. R. W. (2019) · The Social Science Journal · doi:10.1016/j.soscij.2019.08.008 · Cited by 15
“The evidence of the association between perceived social support and depression is extensive (Heinrich & Gullone, 2006; Leskelä et al., 2006; Lynch et al., 1999; Stice, Ragan, & Randall, 2004).”
BackgroundQuality of life and pre-operative anxiety level in patients scheduled to undergo thoracic surgery.
Anagnostopoulou, M., Stroumpoulis, K., Baltayiannis, N., Voyagis, G. S., Haniotis, D., Iacovidou, N. M., Papadimitriou, L., & Xanthos, T. T. (2011) · PubMed · Cited by 13
Koda, N., Watanabe, G., Miyaji, Y., Kuniyoshi, M., Miyaji, C., & Hirata, T. (2016) · Asian Journal of Criminology · doi:10.1007/s11417-016-9232-7 · Cited by 12
“It is known that stressful life events and developmental disorders are risk factors for mental health problems and mental disorders, whereas social support and stress management skills are protective factors (Leskelä et al. 2006; Saxena et al. 2006).”
BackgroundKim, J., Kang, H., Bae, K., Kim, S., Shin, I., Yoon, J., Hong, Y. J., Ahn, Y., Jeong, M. H., & Kim, J.-M. (2018) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217418791439 · Cited by 12
“Perceived SS is the most commonly measured index of SS and is widely used in depression research as a predictor of mental health and support utilization.(26) All other measurements of psychiatric and cardiovascular status were also well validated, and a range of covariates were considered in the analyses.”
Qin, X., Wang, M., Lu, X., Sun, J., Dong, Q., Zhang, L., Liu, J., Ju, Y., Wan, P., Guo, H., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.781738 · Cited by 13
“Social support is associated with the elevated risk (2), severity (41–43), course (44), and outcomes (45) of depression, and even mediates the correlation of depression with suicidal ideation (46).”
BackgroundAdaptive Inferential Feedback Partner Training for Depression: A Pilot Study
Dobkin, R. D., Allen, L. A., Alloy, L. B., Menza, M. A., Gara, M. A., & Panzarella, C. (2007) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2006.09.007 · Cited by 12
O’Shields, J., Mowbray, O. P., & Cooper, Z. (2023) · Social Science & Medicine · doi:10.1016/j.socscimed.2023.116481 · Cited by 12
Jamil, B., & Su, J. (2024) · Journal of American College Health · doi:10.1080/07448481.2023.2299413 · Cited by 11
“42,43 Prior findings indicate that emerging adults consistently endorse lower perceived social support and increased isolation than other age groups.”
Poor mental health in severely obese patients is not explained by the presence of comorbidities
Somerville, R. L., McKenzie, K., Eslami, S., Breen, C., O'Shea, D. B., & Wall, P. G. (2014) · Clinical Obesity · doi:10.1111/cob.12081 · Cited by 9
“In the general population, higher levels of perceived social support have been associated with reduced odds of depression (43), an improved response to treatment for depression (50) and with better psychological well-being (as measured by WHO-5 scores) in the Irish population (34).”
BackgroundJackson, L. T. B., van de Vijver, F. J. R., & Molokoane, D. H. (2013) · SA Journal of Human Resource Management · doi:10.4102/sajhrm.v11i1.504 · Cited by 9
Laurila, M., Lindfors, O., Knekt, P., & Heinonen, E. O. (2024) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2024.2306229 · Cited by 7
“Thus, good social support also buffers responses to stressful events [5] and decreases the risk for depressive [7,8] and anxiety disorders [9,10], being therefore especially important for people otherwise at risk for these disorders.”
BackgroundMechakra-Tahiri, D.-S., Dubé, M., Zunzunegui, M. V., Préville, M., Berbiche, D., & Brassard, J. (2013) · Depression Research and Treatment · doi:10.1155/2013/451708 · Cited by 7
“Some longitudinal studies also found that the severity of life events [28] influences the outcomes of depression.”
BackgroundHoutjes, W., Deeg, D. J. H., van de Ven, P. M., van Meijel, B., van Tilburg, T. G., & Beekman, A. T. F. (2016) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4508 · Cited by 8
“In previous studies, the selected demographic characteristics have shown to be related to social support variables and depression (Houtjes et al., 2014; Leskelä et al., 2006).”
BackgroundPsychological Factors in Arthritis: Cause or Consequence?
Harris, M. L. (2015) · Springer eBooks · doi:10.1007/978-3-319-22858-7_4 · Cited by 7
Mirderikvand, F., اداوی, ح., Amirian, L., & Khodaie, S. (2017) · فصلنامه پرستاری سالمندان · doi:10.21859/jgn.3.2.63 · Cited by 6
Chae, M., Chavez, A., Singh, M. S., Holbrook, J., Glasheen, W. P., Woodard, L., & Adepoju, O. E. (2023) · Gerontology and Geriatric Medicine · doi:10.1177/23337214231201204 · Cited by 5
“Conversely, studies have shown that lower perceived social support predicts higher levels of depressive symptoms among patients followed longitudinally over an 18-month period (Leskelä et al., 2006).”
BackgroundWang, S., Li, J., Li, Y.-B., Xia, Y., Gong, Y., & Mao, F.-Q. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1116650 · Cited by 5
Ruíz-Pérez, I., Ricci‐Cabello, I., Plazaola-Castaño, J., Montero-Piñar, M. I., & Escribà‐Agüir, V. (2011) · Prevention Science · doi:10.1007/s11121-011-0224-7 · Cited by 6
“Furthermore, the effect that a lack of social support has on mental health has already been discussed in previous studies (Leskela et al. 2006), as well as how it can have a greater protective effect on mental health among men (Plaisier et al. 2007).”
BackgroundMcDermott, K. A., Bakhshaie, J., Brewer, J. R., & Vranceanu, A. (2024) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.63543 · Cited by 3
“Social connection is associated with improvements in both depression (Leskelä et al., 2006; Sarwar et al., 2022; Scardera et al., 2020) and anxiety (Hart & Hittner, 1991; Rueger et al., 2010; Scardera et al., 2020) and social support improvements have been shown to mediate the effects of…”
BackgroundDevelopment and validation of the 10-item Social Provisions Scale (SPS-10) Japanese versionPreprint
Katsuki, F., Yamada, A., Kondo, M., Sawada, H., Watanabe, N., Akechi, T., & Rucci, P. (2020) · doi:10.21203/rs.3.rs-19247/v1 · Cited by 3
“Some studies have reported that greater social support deficits predict subsequent higher depressive symptomatology [5, 6].”
BackgroundWozniak, E. E., Hare, D. J., Gregg, L., & Wittkowski, A. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1424010 · Cited by 2
Gender Difference in Perceived Social Support and Clinical Anger in Depressed Patients
Zaidi, U. (2014) · IOSR Journal of Humanities and Social Science · doi:10.9790/0837-191217984 · Cited by 2
Wang, J. (2018) · UCL Discovery (University College London) · doi:10.13140/rg.2.2.22466.61126 · Cited by 2
Oshio, T., Sugiyama, K., & Ashida, T. (2025) · BMC Public Health · doi:10.1186/s12889-025-25826-y · Cited by 1
Relationship Between Believed Causes of Depression and Social Distance
Tomsick, S. J. (2008) · EngagedScholarship @ Cleveland State University (Cleveland State University) · Cited by 1
Zhang, C., Xu, C., Yan, H., Liang, J., Li, X., Tang, C., Yang, Y., Xie, G., & Guo, W. (2024) · The World Journal of Biological Psychiatry · doi:10.1080/15622975.2024.2412651 · Cited by 1
“Limited social support is a significant risk factor for depression (Schwarzbach et al. 2014; Santini et al. 2015) and is linked to less effective recovery from MDD (Leskelä et al. 2006; Joseph et al. 2011).”
Tracy, M. (2012) · Deep Blue (University of Michigan) · Cited by 1
Walby, G. W. (2006) · Digital Commons - University of South Florida (University of South Florida) · Cited by 1
Factors Associated with Post-Stroke Depressive Symptoms and Quality of Life
Johnson, E. A. (2008) · ProQuest Demo Repository · doi:10.7912/c2/1225 · Cited by 1
Sosa, J. M., López‐Morales, H., del Valle, M. V., López, M., Juric, L. C., & Urquijo, S. (2024) · Research Square · doi:10.21203/rs.3.rs-5201070/v1 · Cited by 1
Emotion-modulated startle and the course of major and minor depression
Taylor-Clift, A. (2012) · Digital Commons - University of South Florida (University of South Florida)
DSM-IV vakavan masennustilan pitkäaikaisennuste psykiatrisessa hoidossa
Holma, M. (2010) · STM:n Hallinnonalan avoin julkaisuarkisto (Julkari)
Community Context and Health Disparities Among Older Adults
Zayac, H. M. (2007) · Digital Commons - University of South Florida (University of South Florida)
The association between life adversity and depression in older adult life
Donoghue, H. M. (2014) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York)
Hormones and allostasis in brain disease and repair
Hunter, R. G., & McEwen, B. S. (2008) · Cambridge University Press eBooks · doi:10.1017/cbo9781316529898.006
Women's Experiences Living with Depression
Jarchow, S. M. (2014) · UWM Digital Commons (University of Wisconsin–Milwaukee)
Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology (medical) › 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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