@article{ref1,
title="Factors associated with relapse and recurrence of major depressive disorder in patients starting mindfulness-based cognitive therapy",
journal="Depression and anxiety",
year="2021",
author="de Klerk-Sluis, Jessica M. and Huijbers, Marloes J. and Löcke, Stephan and Spijker, Jan and Spinhoven, Philip and Speckens, Anne E. M. and Ruhe, Henricus G.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Mindfulness-based cognitive therapy (MBCT) is effective for relapse prevention in major depressive disorder (MDD). It reduces cognitive reactivity (CR) and rumination, and enhances self-compassion and mindfulness. Although rumination and mindfulness after MBCT are associated with relapse, the association of CR, rumination, self-compassion, and mindfulness with relapse before initiation of MBCT has never been investigated. <br><br>METHODS: Data were drawn from two randomized controlled trials, including a total of 282 remitted MDD participants (≥3 depressive episodes) who had been using maintenance antidepressant medication (mADM) for at least 6 months before baseline. All participants were offered MBCT while either their mADM was maintained or discontinued after MBCT. CR, rumination, self-compassion, and mindfulness were assessed at baseline by self-rated questionnaires and were used in Cox proportional hazards regression models to investigate their association with relapse. <br><br>RESULTS: CR and mindfulness were associated with relapse, independent of residual symptoms, previous depressive episodes, and mADM-use. Higher CR and lower mindfulness increased the risk of relapse. Self-compassion was not associated with relapse. For rumination, a significant interaction with mADM-use was found. Rumination was associated with relapse in patients who discontinued their mADM, while this effect was absent if patients continued mADM. <br><br>CONCLUSIONS: These results show that CR, rumination, and mindfulness are associated with relapse in remitted MDD-patients before initiation of MBCT, independent of residual symptoms and previous depressive episodes. This information could improve decisions in treatment planning in remitted individuals with a history of depression.<p /> <p>Language: en</p>",
language="en",
issn="1091-4269",
doi="10.1002/da.23220",
url="http://dx.doi.org/10.1002/da.23220"
}