Personality predictors of depression treatment outcome in adult HMO psychiatry clinic outpatients: A naturalistic study of time to remission and course of improvement

This dissertation was inspired by the psychoanalytic writings and research of Sidney Blatt and colleagues whose work suggests that an introjective personality style during a depressive episode will predict a longer time to remission among patients with Major Depressive Disorder in the brief care that is currently commonplace. In a naturalistic study involving group cognitive-behavioral therapy (CBT) and pharmacotherapy for major depression in a large HMO setting, 91 outpatient adults underwent pre-treatment personality/mood testing and Beck Depression Inventory (BDI) screening at each group therapy session. Up to two years of ongoing treatment was offered. The BDI was used to define the time to remission and provided longitudinal data on the trajectory of improvement. It was hypothesized that self-criticism and perfectionism as measured by above-average Comrey Personality Scales (CPS) facet scores for Inferiority Feelings, Cautiousness, and Meticulousness would predict poor treatment outcome.;Pre-treatment Inferiority Feelings predicted time to remission in survival analysis (Wilcoxin chi-square = 7.31, P = .007). Cautiousness predicted depression treatment outcome in both survival analysis (Wilcoxin chi-square = 4.43, P = .035; log-rank chi-square = 5.52, P = .019) and growth curve analysis (slope r = .23, P = .04; residual r = .25, P = .02). The CPS facet called Meticulousness was not a significant predictor of outcome. This study suggests that pre-treatment personality testing for self-criticism and perfectionism using the CPS facets for Inferiority Feelings and Cautiousness may prove clinically useful in choosing optimal treatment for patients with an introjective personality style.