Neurotic depression: delineation of symptom profiles and their relation to outcome

Ninety-one subjects diagnosed clinically as having a 'neurotic depression' were interviewed and then re-assessed at 6 weeks and 20 weeks. Four symptom profiles of clinical features were derived: 'negative cognition', 'lack of drive', 'anxiety', and 'arousal', the last being independent of the other three dimensions and of the severity of depression. Symptom profile scores were then examined against antecedent risk variables and outcome. Links between profile scores and personality variables suggest that personality may colour the clinical presentation of neurotic/reactive depressions, and challenge the assumption that a typology of these depressive disorders based on clinical features is achievable. The break-up of an intimate relationship in the preceding 12 months was a strong predictor of a good outcome. Further analyses suggested, firstly, that there was a distinct subgroup delineated by this life event, with features weighted to the 'arousal' symptom profile, including many symptoms often associated with diagnosis of 'endogenous depression'; and, secondly, that this life event and a good outcome were directly linked, being uninfluenced by personality or other mediating variables.