2026 ECNP Congress

PS03-3133

Distinguishing chronic and non-chronic depression: a clinical profile and symptom networks approach

Paula Rehm — M. Gruber, K.F. Ahrens, H. Staub, F. Timm, L. Krätzig, S. Fischer, S. Edwin Thanarajah, M. Berg, J. Goltermann, N.R. Winter, K. Thiel, T. Borgers, H. Meinert, L.M. Bonnekoh, K. Flinkenflügel, J. Bauer, F. Stein, F. Thomas-Odenthal, P. Usemann, L. Teutenberg, I. Nenadic, B. Straube, N. Alexander, H. Jamalabadi, A. Jansen, N. Opel, S. Meinert, D. Grotegerd, T. Hahn, E.J. Leehr, E. Schramm, M. Elsaesser, W. Rief, A. Reif, T. Kircher, U. Dannlowski, J. Repple · Goethe University Frankfurt- University Hospital, Department for Psychiatry- Psychosomatic Medicine and Psychotherapy, Frankfurt am Main, Germany

2026 ECNP Congress

Introduction

Different disorder courses contribute to the large heterogeneity within depressive disorders. Chronic depression (CD) warrants further investigation given its substantial prevalence and poor treatment outcomes. A longer duration of preceding depression has been associated with diminished treatment response across treatment stages (initial treatment and treatment after repeated non-response) and across modalities, including psychotherapy, antidepressant medication, and neuromodulatory interventions such as transcranial magnetic stimulation [1–3]. This study aims to identify a clinical profile and symptomatic phenotype associated with CD versus non-chronic major depressive disorder (NCD) in a large clinical sample to provide a better characterization of CD.

Methods

The preregistered analyses were based on cross-sectional data from a large German cohort (Marburg/Münster Affective Disorders Cohort Study; MACS), which comprises individuals with psychiatric disorders and healthy controls across two study sites. A subsample of participants with a current or lifetime diagnosis of major depressive disorder (MDD) was analyzed (N = 994; 64.9% female). Retrospective data was used to characterize depression trajectories. CD was defined as the presence of depressive symptoms that persist beyond a temporal threshold of 24 months without remission, irrespective of symptom severity. We assessed associations of nine psychological and social characteristics with CD in logistic regression models. We further examined symptom networks across disorder courses using Bayesian network analysis of Beck’s Depression Inventory (BDI-I) item-level data. This Bayesian approach allowed for a distinction between the absence of evidence and evidence for the absence of individual edges in the networks. In both analyses, we additionally explored a dimensional perspective on chronicity, defined as the cumulative lifetime duration participants have spent in a depressive state.

Results

In our sample, 18.5% of patients with depression met criteria for CD (nCD = 184), whereas 81.5% showed a non-chronic course (nNCD = 810). The following characteristics were associated with CD in single regressions: greater childhood maltreatment, lower age of onset, higher neuroticism, lower extraversion, smaller social networks, l**ess social support, poorer psychosocial functioning, and more psychiatric comorbidities. In a combined model with all characteristics, greater exposure to childhood maltreatment, lower extraversion, and poorer psychosocial functioning were associated with CD, defining a clinical profile distinguishing CD from NCD (R² = 0.25). Symptom networks based on BDI-I items were highly similar across trajectories, differing only by the connection between past failure and self-contempt, which was unique to the CD group. The additional dimensional perspective on chronicity of depression supported the results.

Conclusions

Psychosocial variables, but not symptom profiles, distinguished chronic from non-chronic depression in our study. Thus, characteristics beyond depression symptomatology seem more informative for differentiating depression trajectories. All associations investigated here are cross-sectional, but the identified characteristics represent promising targets for evaluation in future prospective clinical trials. If confirmed longitudinally, they can inform clinical practice by facilitating earlier identification of depression trajectories at risk of becoming chronic and supporting tailored treatment approaches.

References

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  2. Kraus, C., Kadriu, B., Lanzenberger, R., Zarate, C. A., Jr., & Kasper, S. (2019). Prognosis and improved outcomes in major depression: A review. Translational Psychiatry, 9(1), 127. https://doi.org/10.1038/s41398-019-0460-3
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