Depression doesn’t always leave for good with mental health treatment. Unfortunately, for many adults, it quietly creeps back, even after sustained remission. Late-life Depression (LLD) is a relatively common illness for individuals 60 years of age and older, and is characterized by a plethora of symptoms with the capacity to affect nearly every facet of life. In addition to having a higher mortality rate, those with LLD are more susceptible to disability, medical illness comorbidity, suicidal ideation, impaired cognitive functioning, and dementia. These consequences can significantly reduce an individual's quality of life, impacting their relationship dynamics, ability to be independent, and physical health. Given the serious toll that LLD relapse can take on an individual’s well-being, it is incredibly important to study the factors that predict relapse so that more effective, preventative strategies can be implemented in clinical care settings. When clinicians can accurately identify early warning signs of relapse, they can quickly adjust treatment strategies before a full depressive episode sets in, whether that be by increasing the dosage of psychotropic medication, increasing the frequency of cognitive behavioral therapy sessions, or strengthening the patients’ social support circles. This way, mental health practitioners will be more apt to not just treat depression, but also predict and prevent its relapse. Recent research in this domain has offered valuable insight into both the internal risk factors and environmental stress factors that predict LLD relapse.
One study looks predominantly at social, medical, and cognitive factors and their implications for depressive episode relapse in patients with LLD. Olusola Ajilore and colleagues recruited 135 participants with LLD and 69 control group comparison participants with no known mental health disorders. All participants were evaluated according to a variety of standardized tests to assess their psychiatric, social, neurological, and medical history. Participants were then longitudinally assessed for indicators of a depressive episode relapse recurrently over two years. Results showed that 44% of participants in the LLD group experienced a relapse while 56% showed sustained remission. For the individuals in the LLD relapse subgroup, their neuropsychological and behavioral test markers indicated that the main predictors of depressive relapse are higher and more severe levels of rumination, greater medical illness comorbidity, lower executive function performance, lower education level, poorer social support networks, and greater perceived life stress. Furthermore, this subgroup was differentiated from the sustained remission subgroup for their higher levels of self-reported apathy, lower levels of extraversion and conscientiousness, and more severe anxiety symptoms. It should be noted that the two strongest predictor factors of a future relapse were high levels of rumination and medical illness comorbidity. This makes sense given that the severity of self-reflective ruminative thought patterns is likely compounded by additional medical burdens that are unrelated to depression, but still affect any number of other neuropsychological processes and social dynamics. Understanding these predictive factors is critical in the development of personalized and targeted mental health interventions that address not just the depressive symptoms themselves, but also the underlying vulnerabilities that make some individuals more susceptible to relapse than others (Taylor et al., 2024).
A second study supports these findings while providing additional information specifically in regards to the relationship between an individual’s personality traits and their risk of depression relapse. Nada Altaweel and colleagues ran a systematic literature review to investigate which personality traits are associated with major depressive disorder (MDD) episode relapse. They included studies that both assessed MDD relapse using a clinical interview and included a standardized personality test, such as the Big 5 personality test. The personality traits evaluated in this model are extraversion, openness, conscientiousness, agreeableness, and neuroticism. The results indicated that neuroticism, characterized by a tendency to experience negative emotions, such as anxiety, worry, and irritability, was most consistently associated with an increased risk of depression relapse. Furthermore, this study found that the presence of various other mental health disorders also significantly amplified the risk of future relapse after remission. These include borderline personality disorder (BPD) and obsessive-compulsive personality disorder (OCPD). This is because these personality disorders are often characterized by persistent emotional, interpersonal, and cognitive dysregulation that can cause difficulties in daily functioning and ultimately destabilize depression recovery. Lastly, this study found that those with high levels of self-criticism, dependency, impulsivity, and emotional dysregulation, as well as low levels of self-esteem and self-efficacy, were at a heightened risk of MDD relapse as well. Overall, this study investigated the internal personality-based characteristics that make someone more vulnerable to a depressive relapse, often through a heightened tendency to engage in maladaptive thought patterns and behaviors (Altaweel et al., 2023). In summary, both studies identify emotional dysregulation, rumination, and self-criticism, and the presence of comorbid disorders as central contributors to depression relapse. Patients who are in remission from either MDD or LLD and who show these risk factors should be more closely monitored by their mental health professionals so that a relapse can be prevented before it even occurs.
Works Cited:
Altaweel, N., et al. (2023). Personality traits as risk factors for relapse or recurrence in major depression: A systematic review. Frontiers in Psychiatry, 14, Article 1176355. https://doi.org/10.3389/fpsyt.2023.1176355
Taylor W.D., et al (2024). Reconsidering remission in recurrent late-life depression: clinical presentation and phenotypic predictors of relapse following successful antidepressant treatment. Psychological Medicine 54, 4896–4907. https://doi.org/10.1017/S0033291724003246
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