Abstract

Understanding fear of depression recurrence among individuals who are remitted from major depressive disorder: A mixed-methods study

Stephanie Gumuchian, PhD
Concordia University, 2025

Major depressive disorder (MDD) is a prevalent psychiatric condition that significantly impacts functioning and quality of life. A key factor contributing to its high personal, social, and economic burden is the frequent recurrence of depressive episodes, which occurs in 25-40% of individuals diagnosed with MDD. Understanding the cognitive and behavioural changes that occur after a major depressive episode (MDE) and contribute to recurrence risk is crucial for enhancing treatment strategies and preventing future episodes. This mixed-methods thesis investigates the concept of fear of depression recurrence (FoDR), defined as fears that one’s depression may return, among individuals in remission from MDD. Research examining fear of illness recurrence among mental health conditions, including MDD, is limited. Thus, studying FoDR may lead to a better understanding of the changes that occur following an MDE that increase one’s recurrence risk.
In study one, we conducted semi-structured interviews with 30 individuals who are remitted from MDD to explore their experiences with FoDR. We examined the content, triggers, and severity of participants’ fears and evaluated the perceived impact of these fears on daily functioning. Most of the sample (73%) reported experiencing FoDR, with variations in the frequency, severity, and duration of fears. The content and triggers of participants’ FoDR mirrored the experiences that occurred during past MDEs. The impact of FoDR on daily functioning was nuanced, with some reporting a positive, negative, or minimal influence.
In study two, we used the information from our qualitative study to inform the development of a self-report questionnaire designed to capture the multidimensional concept of FoDR. We used exploratory and confirmatory factor analyses to identify the initial factor structure and inform item selection. Our findings supported the retention of a 24-item scale with three factors evaluating the severity, content, and triggers of fears. Our scale demonstrated excellent psychometric properties.
Our results offer initial support for the presence and clinical relevance of FoDR among individuals remitted from MDD. The Fear of Depression Recurrence Questionnaire (FoDRQ) can now be used to explore associations between FoDR and MDD recurrence risk, clinical outcomes, and coping strategies and identify when preventative interventions are needed.