Psychiatry Research 121 (2003) 169–177
0165-1781/03/$ - see front matter ᮊ 2003 Elsevier Ireland Ltd. All rights reserved.
Coping behavior in depressed patients: a longitudinal study
Kumiko Yamada *, Haruo Nagayama , Kounosuke Tsutiyama , Tosinori Kitamura ,
Department of Neuropsychiatry, Oita Medical University, Idaigaoka 1-1, Hasamamatchi, Oita gun, Oita 879-5503, Japan
National Center for Neurology and Psychiatry, Tokyo, Japan
Department of Psychiatry, Nagoya City University Medical School, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
Received 28 October 2002; received in revised form 13 August 2003; accepted 20 August 2003
The relationship of coping behavior to outcome in depressed patients was examined. Subjects (ns105) with major
depressive disorder (ns85), depressive disorder not otherwise specified (ns7) or major depressive disorder with
axis Icomorbidity (ns13) were followed for 6 months. Their coping behavior (i.e. rumination, active distraction,
cognitive distraction and dangerous activities) was defined using the Comprehensive Assessment List for Affective
Disorders. Based on their Hamilton Rating Scale for Depression (HRSD) scores at 6 months, the patients were
categorized as having had a good or a poor outcome. Severity of depression and coping behavior were similar among
the three diagnostic groups. At baseline assessment, coping behavior was not correlated with either HRSD score or
age. However, males were significantly more likely to be engaged in dangerous activity as a coping behavior than
females. Patients with a good outcome at 6 months were significantly more likely to use rumination as a coping
behavior while patients with a poor outcome were significantly more likely to use dangerous activity. Multiple
regression analysis confirmed this finding, indicating that rumination and dangerous activity were significant predictors
of outcome at 6 months. Rumination might be associated with good outcomes in depressed patients while dangerous
activity might be associated with poor outcomes.
ᮊ 2003 Elsevier Ireland Ltd. All rights reserved.
Keywords: Depression; Coping behavior; Rumination; Dangerous activity; Predictor of outcome
Coping style in dealing with stressors has been
suggested to be a key variable in predicting treat-
ment outcome in depressed patients (Weissman et
al., 1978; Shea et al., 1990; Alnaes and Torgersen,
1997; Mazure et al., 2000). While the effects of
various coping behaviors on depression have been
*Corresponding author. Tel.: q81-97-586-5823; fax: q81-
E-mail address: firstname.lastname@example.org (K. Yamada).
reported, no clear picture has emerged. Seeking
social support in depressed patients is associated
with good outcome, while venting of emotion is
linked to poor outcome (Vollrath et al., 1996).
Hopelessness is correlated with severity of depres-
sion (Cannon et al., 1999), and thoughtfulness is
a risk factor for exacerbation of depressive symp-
toms (Hirschfeld et al., 1989).
Sex differences in coping with mood disorders
have also been reported. For example, men are
more likely to engage in distracting behaviors that