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People who are hostile and aggressive, have low levels of dependency on other people or report lower levels of satisfaction from recreational activities are at a higher risk for recurrent bouts of major depression, finds a University of Washington study.

In the study, Jackie Gollan, PhD, a clinical psychology intern at Brown University Medical School, followed for two years 78 patients who had recovered from major depression. The patients had all received 20 sessions of cognitive-behavioral therapy for their depression and were considered symptom-free for at least two months before being accepted into the study.

Participants filled out several questionnaires and self-report surveys to measure their depression, dysfunctional attitudes and pleasant activities. They completed the assessments at the beginning and end of their treatment and every six months during the two-year study. Their personality types were also measured before and after treatment.

At the end of the study, 34 participants, or 44 percent, had relapsed.

"Depression is a recurrent disease that requires repeated treatment for some people," says Gollan. "Many people respond to cognitive-behavioral psychotherapy for depression. However, treatments for depression should address factors beyond depressed mood, like personality, if we are to help individuals stay well."

For instance, the study found that individuals who depend little on others were more likely to relapse.

People who showed aggressiveness at the end of treatment by being hostile and distrusting toward others also were more likely to have another bout of depression, the study found. The reason, Gollan speculates, is that they may not make friends easily and therefore have fewer social supports.

People who reported lower levels of pleasure from their recreational activities, such as going to the movies, exercising or visiting friends, also were more likely to experience repeat depression, according to the study.

"It is becoming clear that people are less at risk for relapse when they continue to do things they enjoy," Gollan says.

Researchers are anxious to identify risk factors for recurrent depression because studies have shown that between 50 percent and 80 percent of patients successfully treated with cognitive behavioral therapy suffer a relapse, often within two years of treatment.

The study was supported by Neil Jacobson, PhD, a University of Washington psychology professor who died last June. Gollan collaborated with him on the study while she was earning her doctorate at the University of Washington. It was funded by a grant from the National Institute of Mental Health.