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Trait and state aspects of harm avoidance and its implication for treatment in major depressive disorder, dysthymic disorder, and depressive personality disorder

Abstract  The authors evaluated the trait/state issues of harm avoidance in depressive‐spectrum disorders and its predictive potential for antidepressant response. Subjects with Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM‐IV) major depressive disorder (n = 39), dysthymic disorder (n = 37), depressive personality disorder (n = 39), and healthy control subjects (n = 40) were evaluated with the Temperament and Character Inventory and the 17‐item Hamilton Depression Rating Scale (HDRS‐17) at baseline and after a 12 week antidepressant treatment period. Higher harm avoidance scores predicted lesser improvement in subjects with dysthymic disorder and major depressive disorder, as determined by lesser decrease in HDRS‐17 scores. Mean harm avoidance scores in depressed subjects were consistently greater than those in healthy controls, controlling for age, gender and diagnosis. Mean harm avoidance scores decreased significantly in all depressive‐spectrum disorders after treatment, but still remained higher than harm avoidance scores in control subjects. The present study reports that harm avoidance is a reliable predictor of antidepressant treatment in subjects with major depressive disorder and dysthymic disorder and that harm avoidance is both trait‐ and state‐dependent in depressive‐spectrum disorders.