Improvement in avoidance in major depressive disorder: A 10-month prospective study of depressive symptoms and...

Avoidance is a key maintaining factor in major depressive disorder (MDD); however, longitudinal evidence remains limited, and its association with personality traits is not fully understood. This study aimed to (1) examine the longitudinal associations among avoidance, depressive symptoms, and rumination and (2) explore the relationship between avoidance and personality traits in outpatients with MDD.

In this 10-month prospective study, 53 adult outpatients diagnosed with MDD were assessed while receiving routine outpatient psychiatric care. Avoidance, depressive symptoms, and rumination were measured at baseline and follow-up using the Cognitive Behavioral Avoidance Scale (CBAS), 17-item GRID-Hamilton Depression Rating Scale (GRID-HAMD-17), and Ruminative Responses Scale (RRS), respectively. Personality traits were assessed at baseline using the Temperament and Personality Questionnaire (T&P). Patients were dichotomized into an Avoidance Improvement (AI) group (≥9-point reduction in CBAS scores) or a Non-Avoidance Improvement (NON-AI) group based on a median split. Univariate and multivariate regression analyses were conducted to identify factors associated with Avoidance Improvement.

The AI group demonstrated greater reductions in depressive symptoms (p = 0.001) and rumination (p = 0.031) than the NON-AI group. In multivariate analysis, greater improvement in depressive symptoms (odds ratio [OR] = 1.130, 95% confidence interval [CI] = 1.016-1.257) and lower baseline Personal Reserve (OR = 0.848, 95% CI = 0.724-0.968) were independently associated with improvement in avoidance.

Reductions in depressive symptoms and lower Personal Reserve may contribute to decreased avoidance in MDD. These findings highlight the importance of targeting depressive symptoms not only for direct relief but also to disrupt maladaptive avoidance cycles.