Major Depression Linked to Self-Esteem, Depression Severity, Hopelessness

sad boy sitting in corner
sad boy sitting in corner
Investigators created a prognostic index to identify factors to predict long-term depression severity after successful and quality acute treatment for major depressive disorder.

Predicting long-term outcomes for major depressive disorder (MDD) after treatment may include several prognostic variables, according to recent study results published in Depression and Anxiety. These variables comprise a prognostic index that could prove effective in predicting the acuteness of subsequent depressive episodes, as well as strategizing future treatment.

For this study, researchers compiled a prognostic index for MDD using a clinical trial of 85 participants, 45 of whom were given cognitive therapy, whereas the remaining 40 were given interpersonal psychotherapy. The Beck Depression Inventory II was used to assess the acuteness of depression, which was the primary measure during 17 months of follow-up. Predictors were identified from 29 possible variables in the domains of demographics, depression, functioning, psychological distress, personal and family history, and psychological processing. In finding the final variables, the study researchers used bootstrap resampling with backwards elimination, as well as model-based recursive partitioning. Cross-validation was employed to obtain each prognostic index score.

Potential predictors were narrowed down to 3 variables: depression acuteness (Beck Depression Inventory, second edition), negative expectations for the future (Beck Hopelessness Scale), and self-esteem (Self Liking and Self Competence Scale, Revised). Acute depression and hopelessness correlated directly with depression scores in the follow-up period, and greater self-esteem showed an inverse relationship with depression during follow-up. Depression acuteness was selected in 96% of bootstrapped samples (100% positive; 0% negative), hopelessness in 70.1% of bootstrapped samples (99.7% positive; 0.3% negative), and self-esteem in 81.5% of bootstrapped samples (0.1% positive; 99.9% negative). All 3 were strongly associated with depression acuteness in follow-up, with an r value of 0.60 (P <.001).

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Limitations of this study included an inability to account for all relevant potential predictors, the lack of validation via an independent testing sample, and the option for individuals to seek additional treatment in follow-up.

The study researchers concluded that “[l]ong‐term predictions of MDD are multifactorial, involving a combination of variables that each has a small prognostic effect. If replicated and validated, the [prognostic index] can be implemented to predict follow‐up depression severity for each individual after acute treatment response, and to personalize long‐term treatment strategies.”


van Bronswijk SC, Lemmens LHJM, Keefe JR, Huibers MJH, DeRubeis RJ, Peeters FPML. A prognostic index for long-term outcome after successful acute phase cognitive therapy and interpersonal psychotherapy for major depressive disorder [published online December 5, 2018]. Depress Anxiety. doi: 10.1002/da.22868