Factors associated with relapse and recurrence of major depressive disorder in patients starting mindfulness-based cognitive therapy

Background Mindfulness-based cognitive therapy (MBCT) is effective for relapse prevention in major depressive disorder (MDD). It reduces cognitive reactivity (CR) and rumination, and enhances self-compassion and mindfulness. Although rumination and mindfulness after MBCT are associated with relapse, the association of CR, rumination, self-compassion, and mindfulness with relapse before initiation of MBCT has never been investigated. Methods Data were drawn from two randomized controlled trials, including a total of 282 remitted MDD participants (>= 3 depressive episodes) who had been using maintenance antidepressant medication (mADM) for at least 6 months before baseline. All participants were offered MBCT while either their mADM was maintained or discontinued after MBCT. CR, rumination, self-compassion, and mindfulness were assessed at baseline by self-rated questionnaires and were used in Cox proportional hazards regression models to investigate their association with relapse. Results CR and mindfulness were associated with relapse, independent of residual symptoms, previous depressive episodes, and mADM-use. Higher CR and lower mindfulness increased the risk of relapse. Self-compassion was not associated with relapse. For rumination, a significant interaction with mADM-use was found. Rumination was associated with relapse in patients who discontinued their mADM, while this effect was absent if patients continued mADM. Conclusions These results show that CR, rumination, and mindfulness are associated with relapse in remitted MDD-patients before initiation of MBCT, independent of residual symptoms and previous depressive episodes. This information could improve decisions in treatment planning in remitted individuals with a history of depression.Stress-related psychiatric disorders across the life spa

Prediction and modification of the risk of future recurrence by mindfulness-based cognitive therapy in patients with major depressive disorder

Stress-related psychiatric disorders across the life spa

The philosophy and practice of interpretivist research in entrepreneurship: Quality, validation and trust

Knowledge production in entrepreneurship requires inclusivity as well as diversity and pluralism in research perspectives and approaches. In this article, the authors address concerns about interpretivist research regarding validity, reliability, objectivity, generalizability, and communicability of results that militate against its more widespread acceptance. Following the nonfoundationalist argument that all observation is theory-laden, context specific, and that there are no external criteria against which to assess research design and execution and the data produced, the authors propose that quality must be internalized within the underlying research philosophy rather than something to be tested upon completion. This requires a shift from the notion of validity as an outcome to validation as a process. To elucidate this, they provide a guiding framework and present a case illustration that will assist an interpretivist entrepreneurship researcher to establish and demonstrate the quality of their work

Three linked risks for development in the Pacific Islands: climate change, disasters and conflict

Pacific Island countries are demonstrably vulnerable to the risks of climate change, disasters and conflict. This article outlines the conceptual links between these risks, briefly describes how each of the risks operates in the Pacific Islands, and goes on to demonstrate the interaction of climate change, disasters and potential for conflict in the Pacific Islands, by applying a new conceptual framework to some illustrative case studies. The case studies include relocation after the Gizo earthquake, ‘environmental refugees’ from sea level rise, and aggravation of the social issues of urbanization and unemployed youth by climate change. Fortunately, none of these cases has yet crossed the threshold into violent conflict, even though relocation of an affected community onto someone else's land is a particularly sensitive issue in the Pacific Islands