Journal of Abnormal Psychology 2000, Vol. 109, No. 2, 299-307 Copyright 2000 by the American Psychological Association, Inc. 0021-843XAXW5.00 DOI: 10.I037//0021-843X.109.2.299 Predictors of Time to Remission From Depression in Primary Care Patients: Do Some People Benefit More From Positive Life Change Than Others? Albertine J. Oldehinkel University of Groningen Johan Ormel University of Groningen and Institute of Psychiatry Jan Neeleman University of Groningen The authors examined the role of personality, social support, and coping strategies and their interaction with positive life change (PLC) in influencing time to remission from depression in 86 depressed primary care patients (69% women, mean age = 36.6 years), who were followed for 3.5 years. Diagnostic information was obtained by the Present State Examination (J. K. Wing, J. Cooper, & N. Sartorius, 1974), and life change by the Life Events and Difficulties Schedule (G. W. Brown & T. O. Harris, 1978). The association of PLC and other predictors with the time to remission was studied by means of Cox regression. PLC reduced time to remission in women, but not in men. Other predictors that expedited remission were low severity of premorbid difficulties, high self-esteem, and a tension-reducing coping style. Neuroticism modified the effect of PLC in that the remission forward bringing effect of PLC was stronger for highly neurotic people. The results suggest that women and psychologically vulnerable persons benefit most from PLC. Positive life change (PLC) has been shown to be associated with remission from depression in the community and in primary care patients (Brown, Adler, & Bifulco, 1988; Brown, Lemyre, & Bifulco, 1992; Leenstra, Ormel, & Giel, 1995; Needles & Abram- son, 1990; Ronalds, Creed, Stone, Webb, & Tomenson, 1997; Tennant, Bebbington, & Hurry, 1981). PLC refers to events and other life changes that restore hope, increase sense of security, and/or provide relief from ongoing stressors. However, PLC is neither a necessary nor a sufficient condition for remission; it does not precede all remissions, and it also occurs in persons who remain ill (Brown et al., 1988; Brown et al., 1992; Leenstra et al., 1995), Therefore, we should take into account the effect of poten- tial "positive life change amplifiers": other factors which may change the effect of PLC (Leenstra et al., 1995). Some of the factors that have been implicated in the course and outcome of depression are neuroticism, self-esteem, social support, and attri- butional style (Brugha, Bebbington, Stretch, MacCarthy, & Wyk- ers, 1997; Katon et al., 1994; Lara, Leader, & Klein, 1997; Needles Albertine J. Oldehinkel and Jan Neeleman, Department of Psychiatry and School of Behavioral and Cognitive Neurosciences, University of Groningen, Groningen, the Netherlands; Johan Ormel, Department of Psychiatry and School of Behavioral and Cognitive Neurosciences, Uni- versity of Groningen, Groningen, the Netherlands, and Institute of Psychi- atry, London, England. Correspondence concerning this article should be addressed to Albertine J. Oldehinkel, Department of Psychiatry, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands. Electronic mail may be sent to a.j.oldehinkel@med.rug.nl. & Abramson, 1990). Furthermore, persistence of depression has been found to be positively related to the severity of the disorder (e.g., Brown et al., 1988; Brown, Bifulco, & Andrews, 1990; Katon et al., 1994; Keller et al., 1992; Lara et al., 1997; Ronalds et al., 1997). The study presented in this article has been built on previous studies on PLC, notably Leenstra et al.'s (1995), by following their recommendations to use robust life change measures and a more sophisticated statistical approach (time-to-event analysis instead of cross tables) and to examine the role of other factors with regard to the effect of PLC on the course of depression. We investigated severity of depression, personality, social support, and coping strategies and studied their unique associations with time to remis- sion and whether they modified the effect of PLC. In other words, we focused on the question of why some people seem to benefit from PLC, whereas others do not. To answer these questions, we followed 86 primary care patients with a recent onset of depressive disorder for approximately 3.5 years. We obtained detailed diag- nostic information by the Present State Examination (PSE-9-Re- vised; Wing, Cooper, & Sartorius, 1974), which was administered three times, whereas we established dates of transitions in diag- nostic status between measurements with Course Interviews (van den Brink, 1988). We assessed positive life change by using the methodology of the Life Events and Difficulties Schedule (LEDS; Brown & Harris, 1978), yielding contextual ratings of events and difficulties on a number of dimensions and dates of occurrence. Information was also gathered on a variety of other potential predictors, such as personality features and coping styles. The large number of variables and the exact dating of events and 299 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.