Skip to main content Accessibility help

Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression

  • W. H. Denton (a1), T. J. Carmody (a1) (a2), A. J. Rush (a1) (a2), M. E. Thase (a3), M. H. Trivedi (a1), B. A. Arnow (a4), D. N. Klein (a5) and M. B. Keller (a6)...



Dyadic discord, while common in depression, has not been specifically evaluated as an outcome predictor in chronic major depressive disorder. This study investigated pretreatment dyadic discord as a predictor of non-remission and its relationship to depressive symptom change during acute treatment for chronic depression.


Out-patients with chronic depression were randomized to 12 weeks of treatment with nefazodone, the Cognitive Behavioral Analysis System of Psychotherapy or their combination. Measures included the Marital Adjustment Scale (MAS) and the Inventory of Depressive Symptomatology – Self Report (IDS-SR30). Of 681 original patients, 316 were partnered and 171 of these completed a baseline and exit MAS, and at least one post-baseline IDS-SR30. MAS scores were analysed as continuous and categorical variables (‘dyadic discord’ v. ‘no dyadic discord’ defined as an MAS score >2.36. Remission was defined as an IDS-SR30 of ⩽14 at exit (equivalent to a 17-item Hamilton Rating Scale for Depression of ⩽7).


Patients with dyadic discord at baseline had lower remission rates (34.1%) than those without dyadic discord (61.2%) (all three treatment groups) (χ2=12.6, df=1, p=0.0004). MAS scores improved significantly with each of the treatments, although the change was reduced by controlling for improvement in depression. Depression remission at exit was associated with less dyadic discord at exit than non-remission for all three groups [for total sample, 1.8 v. 2.4, t(169)=7.3, p<0.0001].


Dyadic discord in chronically depressed patients is predictive of a lower likelihood of remission of depression. Couple therapy for those with dyadic discord may increase remission rates.


Corresponding author

*Address for correspondence: W. H. Denton, M.D., Ph.D., University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9121, USA. (Email:


Hide All
Barbato, A, D'Avanzo, B (2008). Efficacy of couple therapy as a treatment for depression: a meta-analysis. Psychiatric Quarterly 79, 121132.
Broadhead, WE, Blazer, DG, George, LK, Tse, CK (1990). Depression, disability days, and days lost from work in a prospective epidemiologic survey. Journal of the American Medical Association 264, 25242528.
Christian-Herman, JL, O'Leary, KD, Avery-Leaf, S (2001). The impact of severe negative events in marriage on depression. Journal of Social and Clinical Psychology 20, 2440.
Davila, J, Bradbury, TN, Cohan, CL, Tochluk, S (1997). Marital functioning and depressive symptoms: evidence for a stress generation model. Journal of Personality and Social Psychology 73, 849861.
Dessaulles, A, Johnson, SM, Denton, WH (2003). Emotion-focused therapy for couples in the treatment of depression: a pilot study. American Journal of Family Therapy 31, 345353.
Fredman, L, Weissman, MM, Leaf, PJ, Bruce, ML (1988). Social functioning in community residents with depression and other psychiatric disorders: results of the New Haven Epidemiologic Catchment Area study. Journal of Affective Disorders 15, 103112.
Friedman, RA (1993). Social impairment in dysthymia. Psychiatric Annals 23, 632637.
Friedman, RA, Markowitz, JC, Parides, M, Kocsis, JH (1995). Acute response of social functioning in dysthymic patients with desipramine. Journal of Affective Disorders 34, 8588.
Hammen, C (1991). Generation of stress in the course of unipolar depression. Journal of Abnormal Psychology 100, 555561.
Herr, NR, Hammen, C, Brennan, PA (2007). Current and past depression as predictors of family functioning: a comparison of men and women in a community sample. Journal of Family Psychology 21, 694702.
Hickie, I, Parker, G (1992). The impact of an uncaring partner on improvement in non-melancholic depression. Journal of Affective Disorders 25, 147160.
Hirschfeld, RM, Dunner, DL, Keitner, G, Klein, DN, Koran, LM, Kornstein, SG, Markowitz, JC, Miller, I, Nemeroff, CB, Ninan, PT, Rush, AJ, Schatzberg, AF, Thase, ME, Trivedi, MH, Borian, FE, Crits-Christoph, P, Keller, MB (2002). Does psychosocial functioning improve independent of depressive symptoms? A comparison of nefazodone, psychotherapy, and their combination. Biological Psychiatry 51, 123133.
Hollon, SD, Shelton, RC, Wisniewski, S, Warden, D, Biggs, MM, Friedman, ES, Husain, M, Kupfer, DJ, Nierenberg, AA, Petersen, TJ, Shores-Wilson, K, Rush, AJ (2006). Presenting characteristics of depressed outpatients as a function of recurrence: preliminary findings from the STAR*D clinical trial. Journal of Psychiatric Research 40, 5969.
Jacobson, NS, Fruzzetti, AE, Dobson, K, Schmaling, KB, Salusky, S (1991). Marital therapy as a treatment for depression. Journal of Consulting and Clinical Psychology 59, 547557.
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 1219.
Kalmijn, M (2003). Shared friendship networks and the life course: an analysis of survey data on married and cohabiting couples. Social Networks 25, 231249.
Kashner, TM, Carmody, TJ, Suppes, T, Rush, AJ, Crismon, ML, Miller, AL, Toprac, M, Trivedi, M (2003). Catching up on health outcomes: The Texas Medication Algorithm Project. Health Services Research 38, 311331.
Kaslow, N, Warner, V, John, K, Brown, R (1992). Intrainformant agreement and family functioning in depressed and nondepressed parents and their children. American Journal of Family Therapy 20, 204217.
Keller, MB, Lavori, PW, Mueller, TI, Endicott, J, Coryell, W, Hirschfeld, RMA, Shea, T (1992). Time to recovery, chronicity, and levels of psychopathology in major depression – a 5-year prospective follow-up of 431 subjects. Archives of General Psychiatry 49, 809816.
Keller, MB, McCullough, JP, Klein, DN, Arnow, B, Dunner, DL, Gelenberg, AJ, Markowitz, JC, Nemeroff, CB, Russell, JM, Thase, ME, Trivedi, MH, Zajecka, J, Blalock, JA, Borian, FE, Jody, DN, DeBattista, C, Koran, LM, Schatzberg, AF, Fawcett, J, Hirschfeld, RMA, Keitner, G, Miller, I, Kocsis, JH, Kornstein, SG, Manber, R, Ninan, PT, Rothbaum, B, Rush, AJ, Vivian, D, Rothbaum, B (2000). A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine 342, 14621470.
Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, Rush, AJ, Walters, EE, Wang, PS (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289, 30953105.
Kocsis, JH, Frances, AJ, Voss, C, Mason, BJ, Mann, JJ, Sweeney, J (1988). Imipramine and social-vocational adjustment in chronic depression. American Journal of Psychiatry 145, 997999.
Leff, J, Vearnals, S, Brewin, CR, Wolff, G, Alexander, B, Asen, E, Dayson, D, Jones, E, Chisholm, D, Everitt, B (2000). The London Depression Intervention Trial. Randomised controlled trial of antidepressants v. couple therapy in the treatment and maintenance of people with depression living with a partner: clinical outcome and costs. British Journal of Psychiatry 177, 95–100.
Logsdon, MC, Wisner, K, Hanusa, BH, Phillips, A (2003). Role functioning and symptom remission in women with postpartum depression after antidepressant treatment. Archives of Psychiatric Nursing 17, 276283.
McCullough, JP (2000). Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Guilford Press: New York.
McLeod, JD (1993). Spouse concordance for depressive disorders in a community sample. Journal of Affective Disorders 27, 4352.
Miller, IW, Keitner, GI, Schatzberg, AF, Klein, DN, Thase, ME, Rush, AJ, Markowitz, JC, Schlager, DS, Kornstein, SG, Davis, SM, Harrison, WM, Keller, MB (1998). The treatment of chronic depression, part 3: Psychosocial functioning before and after treatment with sertraline or imipramine. Journal of Clinical Psychiatry 59, 608619.
Murphy, SA, Oslin, DW, Rush, AJ, Zhu, J (2007). Methodological challenges in constructing effective treatment sequences for chronic psychiatric disorders. Neuropsychopharmacology 32, 257262.
O'Leary, KD, Beach, SR (1990). Marital therapy: a viable treatment for depression and marital discord. American Journal of Psychiatry 147, 183186.
Papakostas, GT, Petersen, T, Denninger, JW, Tossani, E, Pava, JA, Alpert, JE, Nierenberg, AA, Fava, M (2004). Psychosocial functioning during the treatment of major depressive disorder with fluoxetine. Journal of Clinical Psychopharmacology 24, 507511.
Reimherr, FW, Strong, RE, Marchant, BK, Hedges, DW, Wender, PH (2001). Factors affecting return of symptoms 1 year after treatment in a 62-week controlled study of fluoxetine in major depression. Journal of Clinical Psychiatry 62, 1623.
Rush, AJ, Bernstein, IH, Trivedi, MH, Carmody, TJ, Wisniewski, S, Mundt, JC, Shores-Wilson, K, Biggs, MM, Woo, A, Nierenberg, AA, Fava, M (2006 a). An evaluation of the quick inventory of depressive symptomatology and the Hamilton rating scale for depression: a Sequenced Treatment Alternatives to Relieve Depression Trial report. Biological Psychiatry 59, 493501.
Rush, AJ, Blacker, D, First, MB (2007). Handbook of Psychiatric Measures. American Psychiatric Association: Washington, DC.
Rush, AJ, Gullion, CM, Basco, MR, Jarrett, RB, Trivedi, MH (1996). The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychological Medicine 26, 477486.
Rush, AJ, Trivedi, MH, Ibrahim, HM, Carmody, TJ, Arnow, B, Klein, DN, Markowitz, JC, Ninan, PT, Kornstein, S, Manber, R, Thase, ME, Kocsis, JH, Keller, MB (2003). The 16-item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry 54, 573583, erratum 585.
Rush, AJ, Trivedi, MH, Wisniewski, SR, Nierenberg, AA, Stewart, JW, Warden, D, Niederehe, G, Thase, ME, Lavori, PW, Lebowitz, BD, McGrath, PJ, Rosenbaum, JF, Sackeim, HA, Kupfer, DJ, Luther, J, Fava, M (2006 b). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. American Journal of Psychiatry 163, 19051917.
Trivedi, MH, Rush, AJ, Ibrahim, HM, Carmody, TJ, Biggs, MM, Suppes, T, Crismon, ML, Shores-Wilson, K, Toprac, MG, Dennehy, EB, Witte, B, Kashner, TM (2004). The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychological Medicine 34, 7382.
Vittengl, JR, Clark, LA, Jarrett, RB (2004). Improvement in social-interpersonal functioning after cognitive therapy for recurrent depression. Psychological Medicine 34, 643658.
Weissman, MM, Paykel, ES (1974). The Depressed Woman: A Study of Social Relationships. University of Chicago Press: Chicago.
Weissman, MM, Prusoff, BA, Thompson, WD, Harding, PS, Myers, JK (1978). Social adjustment by self-report in a community sample and in psychiatric outpatients. Journal of Nervous and Mental Disease 166, 317326.
Wells, KB, Burnam, MA, Rogers, W, Hays, R, Camp, P (1992). The course of depression in adult outpatients: results from the Medical Outcomes Study. Archives of General Psychiatry 49, 788794.
Whisman, MA (2001 a). The association between depression and marital dissatisfaction. In Marital and Family Processes in Depression: A Scientific Foundation for Clinical Practice (ed. Beach, S. R. H.), pp. 3–24. American Psychological Association: Washington, DC.
Whisman, MA (2001 b). Marital adjustment and outcome following treatments for depression. Journal of Consulting and Clinical Psychology 69, 125129.
Whisman, MA, Uebelacker, LA, Weinstock, LM (2004). Psychopathology and marital satisfaction: the importance of evaluating both partners. Journal of Consulting and Clinical Psychology 72, 830838.
Wolfinger, R, O'Connell, M (1993). Generalized linear mixed models: a pseudo-likelihood approach. Journal of Statistical Computation and Simulation 48, 233243.


Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression

  • W. H. Denton (a1), T. J. Carmody (a1) (a2), A. J. Rush (a1) (a2), M. E. Thase (a3), M. H. Trivedi (a1), B. A. Arnow (a4), D. N. Klein (a5) and M. B. Keller (a6)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed