Outcome of Dysthymic Disorder at 5-Year Follow-Up: The Effect of Familial Psychopathology, Early Adversity, Personality, Comorbidity, and Chronic Stress

• DOI: 10.1176/appi.ajp.158.11.1864
• Publication Date: 2002-10-11T18:10:43Z
• Authors: Elizabeth P. Hayden; Daniel N. Klein
• Keywords: Adult; Personality Inventory; 05 social sciences; Social Support; Comorbidity; Social Environment; Personality Disorders; Severity of Illness Index; Self Concept; 3. Good health; Life Change Events; Surveys and Questionnaires; Chronic Disease; Humans; 0501 psychology and cognitive sciences; Prospective Studies; Dysthymic Disorder; Stress, Psychological; Follow-Up Studies

This study sought to identify predictors of course and outcome in dysthymic disorder.Eighty-six outpatients with early-onset dysthymic disorder (before age 21) participated in a prospective 5-year follow-up study. Family history of psychopathology, early home environment, axis I and II comorbidity, social support, and chronic stress were assessed at baseline. The Longitudinal Interval Follow-up Evaluation and the Hamilton Depression Rating Scale were used in the follow-up assessments conducted at 30 and 60 months.Comorbid anxiety disorder, cluster C and depressive personality features, and chronic stress were associated with a lower rate of recovery from dysthymic disorder, while family history of bipolar disorder was associated with a higher probability of recovery. Family history of dysthymic disorder, poor childhood maternal and paternal relationships, childhood sexual abuse, cluster C features, neuroticism, a history of anxiety and eating disorders, and chronic stress predicted higher levels of depression at follow-up. Multivariate models indicated that almost all domains contributed to the prediction of course and outcome.The course and outcome of dysthymic disorder is best conceptualized within a multifactorial framework, with family history of psychopathology, early adversity, axis I and II comorbidity, and chronic stress all making important contributions.