In an article titled "The Influence of Cognitive Variables on Recovery in Depressed Inpatients," Bothwell and Scott (1997) report a study done on forty-two unipolar depressed inpatients that were assessed on admission to a hopital and again two years after the onset of the depressive episode. Factors such as "older age, female gender, severity of index episode, median prior duration of episode, higher levels of  dysfunctional attitudes and low self-esteem significantly predicted chronicity of depression" (p. 207).

   This study reported that as "severity of depression subsided, some reduction in dysfunctional attitudes occured" (Bothwell & Scott, 1997, p. 211). The authors also found evidence that higher scores on a Need for Approval scale were associated with non-recovery when controlling for severity of depression. Bothwell and Scott (1997) point out that studies that assess the efficacy of cognitive-behavioral therapy and use of medication found that there are certain 'drug-resistant dysfunctional attitudes' that may call for additional psychological interventions. Premorbid neuroticism has been associated with depression and its association with dysfunctional beliefs and self-esteem can provide essential information to help prognosis.

    The Neuroticism Factor that predisposes people to psychopathology has been associated to cognitive factors (see Bothwell & Scott, 1997 for review). Cognitive factors are supposed to enhance one's vulnerability to persistent depression. Whether cognitive distortions cause or are caused by depression, it is important to devise more reliable and more valid measures of cognitive vulnerability.  The authors hypothesize that by assessing Neuroticism, clinicians tap into cognitive factors that enhance one's diathesis to depression. Bothwell and Scott (1997) postulate that by targeting clinical interventions at improving self-esteem, the prospects of recovery can be greatly enhanced. Their results support a combined  approach to treatment of depression that involves medication to target severe vegetative symptoms and the use of more systematic psychological therapies that target self-esteem and dysfunctional attitudes.
 

Bothwell, R., & Scott, J. (1997). The influence of cognitive variable on recovery in depressed patients. Journal of Affective
        Disorders, 43, 207-212.

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