Familial Dynamics and their Impact on Clinical Outcomes in Greek Patients with Major Depressive Disorder

The present study aimed (a) to examine perceived family functioning in patients with major depressive disorder (MDD) as compared to healthy controls, and (b) to evaluate the association of family functioning, measured at baseline, with repeated assessments of clinical outcomes of MDD. The sample comprised 169 MDD patients (16.0% males and 84.0% females, aged of 47.25 +/- 13.98 years) and 175 controls. Family functioning (FACES-IV) was assessed at baseline in patients and controls. Depression severity (BDI), anxiety levels (STAI-Trait), and suicide risk (RASS) were assessed about 5.04 (+/- 1.16) and 9.56 (+/- 2.52) months after the baseline assessment in MDD patients. Multivariable analysis adjusting for confounders indicated (a) significant differences between families of MDD patients and controls, and (b) an adverse family atmosphere characterised by unbalanced levels of cohesion and flexibility, communication and satisfaction, was found to be a risk factor for certain MDD clinical outcomes. Specifically, for MDD patients, balanced cohesion was negatively associated with anxiety levels and suicidality. Moreover, increased enmeshed levels were related to greater symptom severity and suicidality, whereas increased disengaged levels were associated with anxiety symptoms. Higher chaotic levels were related to increased symptom severity, anxiety and suicide risk. Finally, communication and satisfaction were negatively associated with symptom severity, anxiety and suicide risk. Interventions focused on addressing dysfunctional family interactions through the promotion of family dynamics' awareness may enhance the emotional well-being of individuals with MDD. Future research should focus on longitudinal, culturally sensitive studies exploring mediating and moderating factors, and evaluating family-based interventions to enhance understanding and treatment outcomes for MDD.