Elsevier

Clinical Psychology Review

Volume 64, August 2018, Pages 13-38
Clinical Psychology Review

Review
Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis

https://doi.org/10.1016/j.cpr.2018.07.005Get rights and content
Under a Creative Commons license
open access

Highlights

  • Prognostic risk factors for recurrence were in order of strength of evidence:

    • 1st: childhood maltreatment, residual symptoms and history of prior episodes

    • 2nd: comorbid anxiety, rumination, neuroticism and age of onset

    • Some also may be prescriptive but evidence for such effects was limited

  • Neurocognitive and neuroendocrine factors were identified as potential risk factors

  • A conceptual framework considering the risk factors and mechanisms was developed.

Abstract

Purpose

To review and synthesise prognostic indices that predict subsequent risk, prescriptive indices that moderate treatment response, and mechanisms that underlie each with respect to relapse and recurrence of depression in adults.

Results and conclusions

Childhood maltreatment, post-treatment residual symptoms, and a history of recurrence emerged as strong prognostic indicators of risk and each could be used prescriptively to indicate who benefits most from continued or prophylactic treatment. Targeting prognostic indices or their “down-stream” consequences will be particularly beneficial because each is either a cause or a consequence of the causal mechanisms underlying risk of recurrence. The cognitive and neural mechanisms that underlie the prognostic indices are likely addressed by the effects of treatments that are moderated by the prescriptive factors. For example, psychosocial interventions that target the consequences of childhood maltreatment, extending pharmacotherapy or adapting psychological therapies to deal with residual symptoms, or using cognitive or mindfulness-based therapies for those with prior histories of recurrence. Future research that focuses on understanding causal pathways that link childhood maltreatment, or cognitive diatheses, to dysfunction in the neocortical and limbic pathways that process affective information and facilitate cognitive control, might result in more enduring effects of treatments for depression.

Keywords

Depression
Depressive disorder
Major
Recurrence
Review
Risk factors

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