We considered two leading hypotheses that potentially could explain the underlying mechanism for the high risk for recurrence: (I) the vulnerability-accumulation or scarring hypothesis and (II) the premorbid vulnerability hypothesis. Our aim was to investigate specific premorbid factors (e.g. genetics, childhood trauma) that are present before MDD onset as well as the specific biological factors that could play a premorbid role and/or are involved in vulnerability-accumulation ('scarring'). These biological variables were collected in different stadia in the course of MDD-R, i.e. the remitted phase, subsyndromal phase and acute depressive state. Studies in this thesis are mostly based on data collected from the participants of the DELTA study: a well-defined high-risk population for relapse and recurrence as it includes exclusively remitted patients with at least two previous depressive episodes.
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