Are Axis IV Criteria Predictive of Future Depressive Episodes?

According to the DSM-IV, psychosocial stressors and environmental stressors that have occurred in the prior 12 months of someone’s life may be predictive of future depressive episodes in individuals with major depression (MDE).  This is covered in what is called the Axis-IV section of the DSM-IV. When clinicians use this method to assess symptoms, they can also report any events that may be relevant to MDE, even if they did not occur in the 12 months prior to assessment. These may include childhood maltreatment such as sexual abuse, neglect, or other forms of adversity. But until now, few studies have looked specifically at these factors and measured their predictive value in a longitudinal follow-up format.

Stephen E. Gilman of the Department of Society, Human Development, and Health at the Harvard School of Public Health in Massachusetts decided to conduct a study to determine if these criteria were effective at predicting future depressive episodes in people with a history of MDE. Gilman reviewed surveys from over 34,000 adults with a history of MDE in the year preceding the survey. He analyzed all data relative to the study parameters and surveyed the participants again three years later to determine if any of the factors examined were predictive of future depression. He also looked at how mood, substance use, or anxiety issues were influenced by these same factors.

Gilman found that prior year environmental and psychosocial stressors coupled with childhood adversity and trauma did predict future episodes of depression in this sample of adults. Childhood maltreatment and trauma also increased the risk of suicide in those with depression. But without stress of childhood adversity, prior year stressors alone did not increase suicide risk or suicidal ideation in the participants. When he looked at other psychological problems, Gilman found similar trends. For mood, anxiety, and substance use issues, prior year and childhood history all influenced future relapses and future symptomology. He believes that the experience of prior stressors, especially those in childhood, could make one more vulnerable to stress and put them at increased risk for psychological problems. It also had the potential to diminish the effects of treatment. Gilman believes approaches that target social and childhood adversity may be the most beneficial to individuals with a history of MDE. “We conclude from these results that the presence of psychosocial and environmental stressors should be maintained as part of the diagnostic evaluation in a multi-axial diagnostic classification,” said Gilman.

S. E. Gilman, et al. Psychosocial stressors and the prognosis of major depression: A test of Axis IV. Psychological medicine43.2 (2013): 303-16. ProQuest Research Library. Web. 20 Feb. 2013.

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  • Grace

    February 27th, 2013 at 11:45 PM

    It was surprising at first to read that an episode in the prior year can bring in depression. thanks for clearing it up that non significant events do not bring in depression all by themselves.

    Childhood trauma is understandable but isn’t that a bit too old to affect a person after a log gap? I mean I could understand if a problem persists through the years but a blast from the past coming to haunt someone all of a sudden-is it really that common?!

  • Noel

    February 28th, 2013 at 3:58 AM

    I kind of see where you are going with this, but I just always assumed that once you had once been depressed and had additionally faced any other kind of stressor in life then there would always be a greater chance for a relapse or replicated condition.

  • randall

    February 28th, 2013 at 10:58 PM

    I hate it that those who go through an issue have to constantly live in fear of a reoccurance. Almost like they become weakened and could suffer from another attack any time. We need more ways of shielding these people from repeat problems or it could well lead to a feeling of having no hope and we all know how that could play out!

  • Chris

    April 23rd, 2013 at 11:23 PM

    Hi Grace

    As much of what happens in trauma can be stored in the subconscious, a later trigger can bring associated feelings to the surface many years, even decades later. The body holds memory, and if it is not sufficiently integrated into the psyche, it will seek to do so later in life. Mid-life is a time when the unconscious calls ( so to speak) us to deal with feelings that will no longer remain suppressed.


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