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White matter fiber microstructure is associated with prior hospitalizations rather than acute symptomatology in major depressive disorder

Published online by Cambridge University Press:  14 September 2020

Susanne Meinert
Department of Psychiatry, University of Münster, Münster, Germany
Elisabeth J. Leehr
Department of Psychiatry, University of Münster, Münster, Germany
Dominik Grotegerd
Department of Psychiatry, University of Münster, Münster, Germany
Jonathan Repple
Department of Psychiatry, University of Münster, Münster, Germany
Katharina Förster
Department of Psychiatry, University of Münster, Münster, Germany Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
Nils R. Winter
Department of Psychiatry, University of Münster, Münster, Germany
Verena Enneking
Department of Psychiatry, University of Münster, Münster, Germany
Stella M. Fingas
Department of Psychiatry, University of Münster, Münster, Germany
Hannah Lemke
Department of Psychiatry, University of Münster, Münster, Germany
Lena Waltemate
Department of Psychiatry, University of Münster, Münster, Germany
Frederike Stein
Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
Katharina Brosch
Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
Simon Schmitt
Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
Tina Meller
Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
Anna Linge
Department of Psychiatry, University of Münster, Münster, Germany
Axel Krug
Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
Igor Nenadić
Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
Andreas Jansen
Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany Core-Unit Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
Tim Hahn
Department of Psychiatry, University of Münster, Münster, Germany
Ronny Redlich
Department of Psychiatry, University of Münster, Münster, Germany
Nils Opel
Department of Psychiatry, University of Münster, Münster, Germany Interdisciplinary Centre for Clinical Research (IZKF) Münster, University of Münster, Münster, Germany
Ricarda I. Schubotz
Department of Psychology, University of Münster, Münster, Germany
Bernhard T. Baune
Department of Psychiatry, University of Münster, Münster, Germany Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
Tilo Kircher
Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
Udo Dannlowski*
Department of Psychiatry, University of Münster, Münster, Germany
Author for correspondence: Udo Dannlowski, E-mail:



Eighty percent of all patients suffering from major depressive disorder (MDD) relapse at least once in their lifetime. Thus, understanding the neurobiological underpinnings of the course of MDD is of utmost importance. A detrimental course of illness in MDD was most consistently associated with superior longitudinal fasciculus (SLF) fiber integrity. As similar associations were, however, found between SLF fiber integrity and acute symptomatology, this study attempts to disentangle associations attributed to current depression from long-term course of illness.


A total of 531 patients suffering from acute (N = 250) or remitted (N = 281) MDD from the FOR2107-cohort were analyzed in this cross-sectional study using tract-based spatial statistics for diffusion tensor imaging. First, the effects of disease state (acute v. remitted), current symptom severity (BDI-score) and course of illness (number of hospitalizations) on fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity were analyzed separately. Second, disease state and BDI-scores were analyzed in conjunction with the number of hospitalizations to disentangle their effects.


Disease state (pFWE < 0.042) and number of hospitalizations (pFWE< 0.032) were associated with decreased FA and increased MD and RD in the bilateral SLF. A trend was found for the BDI-score (pFWE > 0.067). When analyzed simultaneously only the effect of course of illness remained significant (pFWE < 0.040) mapping to the right SLF.


Decreased FA and increased MD and RD values in the SLF are associated with more hospitalizations when controlling for current psychopathology. SLF fiber integrity could reflect cumulative illness burden at a neurobiological level and should be targeted in future longitudinal analyses.

Original Article
Copyright © The Author(s), 2020. Published by Cambridge University Press

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