Using Psychological Vulnerability Markers to Predict the Course of Affective Disorders

Routine assessments of these markers should be conducted before and during treatment as they may inform prognoses.

Research published in the Journal of Psychiatric Research found that psychological vulnerabilities linked with specific disorders predicted the course of those disorders.

Psychological vulnerabilities are thought to affect the development of affective disorders, and prior cross-sectional research has demonstrated associations between several markers of general psychological vulnerabilities with both depression and anxiety. Markers of specific cognitive vulnerabilities are more strongly connected with either depression or anxiety. The aim of this study was to examine the specificity of these markers in predicting the course of depression and anxiety disorders.

Researchers examined data from 1256 participants at baseline, 2-year, and 6-year follow-up from The Netherlands Study of Depression and Anxiety, an ongoing longitudinal cohort study of the long-term course of depression and anxiety. Participants had been previously diagnosed with depressive disorders, major depressive disorder or dysthymia, and anxiety disorders, panic disorder, social anxiety disorder, or generalized anxiety disorder. Analyses used the subscales of Neuroticism and Extraversion from the Dutch NEO Five-Factor Inventory; The Mastery Scale was used to measure locus of control. The Rumination on Sadness and Hopelessness Reactivity subscales of the Leiden Index of Depression Sensitivity-Revised were used to assess rumination and hopelessness. The Penn State Worry Questionnaire assessed pathological worry, and the Anxiety Sensitivity Index assessed the degree to which participants feared anxiety symptoms. After 2- and 6-year follow-up assessment, logistical regression models were constructed and then adjusted for diagnosis, age, gender, and education.

Researchers found that all psychological vulnerability constructs were significantly intercorrelated, and that most psychological vulnerabilities predicted the 2-year presence of all depression and anxiety disorders and chronicity of depression and anxiety symptoms. In multivariate models, neuroticism, extraversion, and locus of control accurately predicted a worse course of both depression and anxiety. Rumination was related only to depression across all outcomes and assessment periods. Worry was related only to Generalized Anxiety Disorder (GAD), and anxiety sensitivity was related only to anxiety. Hopelessness was not related to depression or anxiety, but did predict chronic symptoms of depression and anxiety at year 6. When including comorbid disorders in the analysis, the results did not change.

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The limitations of this study include: cases of comorbidity were included in the study, which could have diminished specificity; the study drop-outs differed in psychopathology from study-completers; and only self-report measures of psychological vulnerabilities were used. Diagnostic outcomes did not include post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD). In addition, item overlap in criteria could explain some of the determined associations.

The clinical implications of this study are that routine assessments of these markers should be conducted before and during treatment, as they may inform prognoses. These assessments may also assist in determining the focus of treatment, since psychological vulnerabilities are likely factors in the onset and course of psychopathology. Stable vulnerabilities also seem responsive to psychological intervention.

The researchers concluded that “the results support the notion of specific as well as transdiagnostic predictive factors for the [long-term] course of affective disorders, which is in line with current hierarchical models of psychopathology.”


Struijs SY, Lamers F, Spinhoven P, van der Does W, Penninx BWJH. The predictive specificity of psychological vulnerability markers for the course of affective disorders [published online April 2018]. Journal of Psychiatric Research. doi:10.1016/j.jpsychires.2018.04.017