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Published Online: 1 March 2011

Relationship of Personality Disorders to the Course of Major Depressive Disorder in a Nationally Representative Sample

Abstract

Objective:

The purpose of this study was to examine the effects of specific personality disorder comorbidity on the course of major depressive disorder in a nationally representative sample.

Method:

Data were drawn from 1,996 participants in a national survey. Participants who met criteria for major depressive disorder at baseline in face-to-face interviews (in 2001–2002) were reinterviewed 3 years later (in 2004–2005) to determine persistence and recurrence. Predictors included all DSM-IV personality disorders. Control variables included demographic characteristics, other axis I disorders, family and treatment histories, and previously established predictors of the course of major depressive disorder.

Results:

A total of 15.1% of participants had persistent major depressive disorder, and 7.3% of those who remitted had a recurrence. Univariate analyses indicated that avoidant, borderline, histrionic, paranoid, schizoid, and schizotypal personality disorders all elevated the risk for persistence. With axis I comorbidity controlled, all personality disorders except histrionic personality disorder remained significant. With all other personality disorders controlled, borderline and schizotypal disorders remained significant predictors. In final, multivariate analyses that controlled for age at onset of major depressive disorder, the number of previous episodes, duration of the current episode, family history, and treatment, borderline personality disorder remained a robust predictor of major depressive disorder persistence. Neither personality disorders nor other clinical variables predicted recurrence.

Conclusions:

In this nationally representative sample of adults with major depressive disorder, borderline personality disorder robustly predicted persistence, a finding that converges with recent clinical studies. Personality psychopathology, particularly borderline personality disorder, should be assessed in all patients with major depressive disorder, considered in prognosis, and addressed in treatment.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 257 - 264
PubMed: 21245088

History

Received: 11 May 2010
Revision received: 4 August 2010
Revision received: 13 October 2010
Accepted: 18 October 2010
Published online: 1 March 2011
Published in print: March 2011

Authors

Details

Andrew E. Skodol, M.D.
From the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York; and the New York State Psychiatric Institute, New York.
Carlos M. Grilo, Ph.D.
From the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York; and the New York State Psychiatric Institute, New York.
Katherine M. Keyes, M.P.H., Ph.D.
From the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York; and the New York State Psychiatric Institute, New York.
Timothy Geier, B.A.
From the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York; and the New York State Psychiatric Institute, New York.
Bridget F. Grant, Ph.D.
From the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York; and the New York State Psychiatric Institute, New York.
Deborah S. Hasin, Ph.D.
From the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York; and the New York State Psychiatric Institute, New York.

Notes

Address correspondence and reprint requests to Dr. Skodol, Sunbelt Collaborative, 4031 E. Sunrise Dr., Suite 101, Tucson, AZ 85718; [email protected] (e-mail).

Funding Information

The authors report no financial relationships with commercial interests.Supported in part by grant U01AA018111, from the National Institute on Alcohol Abuse and Alcoholism, and grant K05 AA014223, from the National Institute of Mental Health (Dr. Hasin), and by the New York State Psychiatric Institute.

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