Prediction of Improvement in Medical Treatment for Depression: Using Self-Report Measures of Erikson's Stages

Patients with depression are known to vary widely in their response to treatment with antidepressant medication (Hirschfeld and Goodwin 1988; Spigset and Martensson 1999). The primary variable that predicts response to treatment is the level of the individual's psychological functioning at the beginning of treatment (Bifulco et al. 1998). In this study we tested the

hypothesis that patients' ratings of their developmental fixations would predict treatment response over and above initial evaluations of depressive symptomatology. Earlier research has shown that patients with treatment-resistant depression often have early childhood trauma or other life stressors that may contribute to the difficulty in achieving remission of depressive symptoms (Dube et al. 2005; Heim and Nemeroff 2001). Early childhood trauma and/or ongoing developmental obstacles beyond infancy could lead to serious obstacles to satisfaction in adult life. External events that upset tenuous balances (e.g., job loss, divorce, children leaving for college, retirement of a spouse) can unmask problems in self-regulation that culminate in major depression (Spigset and Martensson 1999); depressions of this sort are not easily resolved with medication treatment (Nemeroff et al. 2003). The authors sought a means of identifying depressed patients' baseline psychological functioning apart from their symptom presentation and correlating this baseline with response to treatment.

Patients were recruited by the lead author from her practice at a large university mental health center. All subjects gave written consent according to Institutional Review Board protocol for the university and underwent testing with the Structured Clinical Interview for Depression (SCID), the Beck Depression Inventory (BDI), and the Inventory for Psychosocial Balance (IPB) described below.

Each patient was evaluated clinically and assigned a Global Assessment of Functioning (GAF) score by the treating psychiatrist. At follow-up