








































Graduate Student Journal of Psychology                                                                             Copyright 2005 by the Department of Counseling & Clinical Psychology 


Graduate Student Journal of Psychology                                                                             Copyright 2006 by the Department of Counseling & Clinical Psychology  
2006, Vol. 8                                                                                                                          Teachers College, Columbia University                          ISSN 1088-4661 
 
 
 

Patient Predictors of Response 
to Interpersonal Psychotherapy (IPT) for Depression 

 
Jessica A. Keith 

Teachers College, Columbia University 
 

Researchers in the past 20 years have identified a number of patient-specific variables that appear 
to moderate response to IPT for depression. These factors include length of the depressive epi-
sode, biological sleep profile, baseline social functioning, adult attachment profile, level of per-
fectionism, presence of personality disorder, level of somatic anxiety, and expectations about 
treatment. The therapeutic alliance is also important to consider, as it may interact with patient 
characteristics to influence outcome. The evidence for each of these factors is presented in order 
to begin to create a profile of patients who are more likely to respond to IPT for depression. Im-
plications for clinical practice and future research directions are discussed. 

 
 

The psychotherapy treatment literature provides evi-
dence that a single treatment is not appropriate for all pa-
tients with the same disorder. Interpersonal Psychotherapy 
(IPT), a time-limited, manualized treatment that focuses on 
the relationship between depression and current interper-
sonal problems (Weissman, Markowitz, & Klerman, 2000), 
is no exception. Having established that IPT is a generally 
efficacious treatment for Major Depressive Disorder (e.g., 
Elkin et al., 1989), researchers have begun examining the 
characteristics of depressed patients for whom IPT is most 
appropriate. Though the literature in the area of patient-
related moderators of response to IPT is in the early stages, 
some predictors of response have emerged. This research is 
important to consider for several reasons. Perhaps most 
valuable is this information’s clinical utility in the selection 
of depressed patients suited to receive IPT. If certain char-
acteristics of depressed patients can serve as markers of 
more likely IPT response, treatment decisions can be en-
hanced from the outset. An increased focus on response 
predictors may also further understanding about the mecha-
nisms through which IPT exerts its ameliorative effects, 
thereby leading to enhancements in this valuable treatment. 
In comparing results of the studies reviewed, it is important 
to consider the definition of “response” to IPT that is used. 
Many studies define response as “complete recovery” from 
the presenting depressive episode by the termination of 
treatment, operationalized via a cut-off score less than or 
equal to 6 or 7 on the 17-item version of the Hamilton Rat-
ing Scale for Depression (HRSD), an established, clinician-
administered measure of depression symptoms (Hamilton, 
1960). Other studies define response as remission from the 
current depressive episode, operationalized as a score of 7 

 
Correspondence concerning this article should be addressed to 
Jessica A. Keith, Box 102, Department of Counseling and Clinical 
Psychology, Teachers College, Columbia University, 525 West 
120  Street, New York, NY 10027; e-mail: 
jak208@columbia.edu.

th

  

or below on the HRSD for a number of consecutive weeks 
(usually 3 or 4). In addition to response to IPT, outcome is 
addressed in the research, defined as the continuous HRSD 
score at termination. Other studies include number of weeks 
to remission as an outcome variable of interest. 

 

Overview of Studies Reviewed 
 
Many of the findings reviewed in this article are based 

on the National Institute of Mental Health (NIMH) Treat-
ment of Depression Collaborative Research Program 
(TDCRP), a randomized, multi-site clinical trial comparing 
the efficacy of IPT, cognitive behavior therapy (CBT), 
imipramine hydrochloride plus clinical management 
(imipramine-CM), and pill-placebo plus clinical manage-
ment for non-bipolar, non-psychotic depressed patients (El-
kin et al., 1989). Subjects were adult outpatients with a di-
agnosis of a current major depressive episode and scores of 
14 or higher on the HRSD. Treatment in each condition 
consisted of 16 to 20 sessions conducted over 16 weeks by 
experienced psychologists and psychiatrists trained to de-
liver treatment in accord with detailed manuals. Two hun-
dred fifty subjects were randomized, 239 entered the treat-
ment, and 162 completed the 16-week trial. All four treat-
ments were effective in reducing depressive symptoms and 
improving functioning, with IPT and CBT as effective as 
imipramine-CM. IPT and imipramine-CM were signifi-
cantly more effective than placebo in reducing depression 
severity as measured by the HRSD (Elkin et al., 1989).  

Other findings reviewed here are from studies of outpa-
tient maintenance IPT for recurrent unipolar depression 
conducted by Frank and colleagues (Feske, Frank, Kupfer, 
Shear, & Weaver, 1998; Cyranowski, et al., 2002). Subjects 
were experiencing at least a second episode of major de-
pression and had scores of over 14 on the HRSD. Subjects 
received 12 to 24 weeks of IPT, ending when remission 

3 



KEITH 
 

 4 

(defined as 3 consecutive weeks with HRSD <= 7) was 
achieved, at the end of 24 weeks, or at patient dropout (the 
later two groups were classified as non-remitters). Addi-
tional findings in this article are taken from Brown and col-
leagues’ randomized controlled trial of IPT, nortriptyline, 
or usual care for patients with DSM-III major depression 
recruited from internal medicine clinics and family health 
centers (Brown, Schulberg, Madonia, Shear, & Houck, 
1996; Brown, Schulberg, & Prigerson, 2000). Subjects had 
scores of 13 or higher on the HRSD. All treatments lasted 8 
months; IPT included 16 weekly sessions followed by 4 
monthly continuation-phase sessions. Findings from several 
other studies of IPT are described as they appear in the re-
view below. Note that studies of IPT used in combination 
with pharmacotherapy (e.g., Dew et al., 1997; Greenhouse, 
Kupfer, Frank, Jarrett, & Rejman, 1987; Reynolds et al., 
1996) are not included in this review, as the impact of IPT 
versus the drug treatment on response is unclear. 

 

Key Patient Predictors of IPT Response 
 
Researchers in the past 20 years have identified a num-

ber of patient-specific variables that appear to predict re-
sponse to IPT for depression. These factors include the se-
verity, onset, and duration of the patient’s depression, de-
pression of the endogenous type, social functioning, marital 
status, adult attachment profile, perfectionism, personality 
disorder, anxiety, and expectations about treatment. The 
evidence for each of these factors is presented. 

 
Features of Depression 

 
Features of a patient’s depression, such as severity, du-

ration, and onset may impact response to treatment. Exam-
ining the role of depression severity in the TDCRP study, 
Elkin and colleagues (1989) found that patients classified as 
having more severe baseline depression (HRSD >= 20) and 
more impaired baseline functioning defined via the Global 
Assessment Scale (GAS <= 50) had significantly lower 
depression scores and a greater chance of recovery (HRSD 
<= 6) at termination in the IPT and imipramine-CM condi-
tions compared to placebo. In contrast, Feske and col-
leagues (1998) found that greater baseline depressive sever-
ity and GAS functional impairment predicted non-response 
to IPT. Brown, Schulberg, and Prigerson (2000) similarly 
found that baseline depression severity and functional im-
pairment did not predict recovery (HRSD <= 7) at 8-month 
termination for the IPT group. Regarding duration of the 
current depressive episode, Sotsky and colleagues (1991) 
observed that across all TDCRP treatment groups episodes 
of 6 months duration or more were correlated with greater 
post-treatment depression severity. Feske and colleagues 
(1998) similarly found that longer duration of the index 
episode of depression was associated with non-remission. 
Depression with greater acuteness of onset (less than 3 
months) predicted less depression severity at termination 

for patients treated with IPT or imipramine-CM in TDCRP 
(Sotsky et al., 1991).  

Endogenous depression—that is, depression that is less 
situational and more innate or biological in nature—has 
long been thought to respond better to somatic treatments 
than to psychotherapy (Prusoff, Weissman, Klerman, & 
Rounsaville, 1980). However, the findings regarding IPT’s 
effect on endogenous depression are mixed. In a study of 96 
acutely depressed ambulatory patients, Prusoff and col-
leagues (1980) found that subjects with endogenous depres-
sion defined by Research Diagnostic Criteria (RDC) re-
sponded poorly to IPT alone, but positively when IPT was 
combined with pharmacotherapy. Patients not meeting cri-
teria for RDC endogenous depression responded well to 
IPT. In contrast, Sotsky et al. (1991) found that RDC en-
dogenous depression predicted reduction in depression se-
verity in the IPT group. Feske et al. (1998) similarly found 
that subjects who failed to remit with IPT were more likely 
to meet RDC criteria for non-endogenous depression. An 
additional analysis of TDCRP data by Sotsky in 1997 found 
that subjects with symptoms of atypical depression (mood 
reactivity, hypersomnia, hyperphagia, or weight gain) re-
sponded better to IPT and CBT than to imipramine-CM or 
placebo (cited in Weissman, et al., 2000).  

Commenting on the disagreement in the literature 
about the role of endogenous depression in moderating IPT 
response, Thase and colleagues (1997) noted a general lack 
of consensus about the features that best define endogenous 
depression. They proposed that EEG sleep information 
could more accurately identify patients with biological dis-
turbances characteristic of endogenous depression. In a 
study of 91 subjects with unipolar or bipolar II depression, 
they examined the predictive utility of EEG sleep profiles 
to outcome from IPT. Subjects received two nights of EEG 
sleep recording to measure REM latency, sleep efficiency, 
and REM density, factors that have reliably discriminated 
between depressed and healthy subjects in previous re-
search. Subjects were then divided into two groups, one 
which met the profile for an abnormal sleep profile similar 
to depressed inpatients (n = 41) and the other with a normal 
sleep profile (n = 50). All subjects were treated with up to 
16 weekly sessions of IPT. Subjects with abnormal sleep 
profiles had significantly poorer response to IPT as meas-
ured by HRSD ratings, treatment attrition, and depression 
remission (defined as 4 consecutive weeks with HRSD <= 
7). Biologically disturbed patients appeared to respond 
poorly to IPT even though pretreatment depression severity 
did not impact outcome. The authors concluded that IPT 
may less effective for a subgroup of endogenously de-
pressed patients (those with objective signs of neurobio-
logical dysfunction), thus explaining the lack of agreement 
in earlier findings. 
 
Social Functioning 
 

IPT is based on the principle that depression can be 
treated by focusing on the interpersonal context (Weissman, 



PATIENT PREDICTORS OF RESPONSE TO IPT 
 

 5

et al., 2000); thus, pretreatment social functioning might be 
expected to have an impact on IPT’s outcome. Sotsky et al. 
(1991) found that less pretreatment social dysfunction, as 
measured by the 11-item social and leisure activities sub-
scale of the clinician-administered Social Adjustment Scale 
(SAS), was associated with less depression severity and 
complete response across all four treatments at termination, 
but most markedly for IPT. Subjects with more severe so-
cial deficits responded poorly to IPT. Patients who had 
lower social dysfunction prior to treatment, higher interper-
sonal sensitivity, and higher satisfaction with interpersonal 
relationships tended to be more responsive to IPT. The au-
thors theorized that patients might need a minimum base-
line social functioning ability in order to respond well to 
IPT. In contrast, Feske et al. (1998) found that subjects who 
did not respond to IPT had higher levels of social function-
ing, as measured by the Social Attainment Scale, than those 
who did. Though these two studies used different measures 
of social functioning and different definitions of response, 
the discrepancy in their findings requires further research. 
Also of note, it has been found that subjects in the TDCRP 
who were divorced or separated responded better to IPT, 
whereas married patients responded better to CBT (Barber 
& Meunz, 1996). Marital status was not significantly re-
lated to IPT outcome in either the Feske et al. (1998) or 
Brown and colleagues (2000) studies. The relationship of 
marital status to social functioning in the prediction of re-
sponse to IPT remains to be explored in detail.   

Further investigating the role of social functioning, 
Cyranowski and colleagues (2002) reported data indicating 
that adults with insecure attachment styles may have poorer 
interpersonal functioning and higher vulnerability to de-
pression. They described three patterns of adult insecure 
attachment—preoccupied, dismissing-avoidant, and fearful-
avoidant—each with implications for interpersonal func-
tioning. They examined data from 162 female participants 
with recurrent depression in Frank’s study of maintenance 
IPT to explore the relationship of adult attachment status to 
treatment response. Attachment styles were measured by 
the self-rated Relationship Questionnaire. The authors 
found that though the proportion of subjects who remitted 
(HRSD <= 7 for 3 consecutive weeks) did not differ by 
attachment profile, among subjects who did remit (n = 87), 
those with secure attachment had significantly less time to 
remission (mean 8.5 weeks) than those with fearful-
avoidant attachment (mean 13 weeks). In this sample, 
women with fearful-avoidant attachment profiles tended to 
have a more negative view of self and others, more trouble 
socializing, and more interpersonal difficulties. Although 
women with this profile responded to IPT in equal propor-
tion to those who were securely attached, they responded 
more slowly. Though limited by its use of a self-report 
measure of attachment style, this study provides evidence 
that a brief course of IPT may not be enough time for fear-
ful-avoidant patients to develop a trusting relationship. 

 
Perfectionism 

A series of studies examining TDCRP data has pro-
vided strong evidence for the damaging role of perfection-
ism on response to treatment. Authors using TDCRP data 
have assessed perfectionism via the Dysfunctional Attitudes 
Scale (DAS), a measure of cognitive dysfunction that as-
sesses self-critical and socially dependent attitudes. Overall, 
TDCRP subjects with lower cognitive dysfunction as meas-
ured by the DAS tended to respond better to CBT and 
imipramine-CM than to placebo (Sotsky et al., 1991). Cog-
nitive dysfunction did not predict IPT response. Using a 
principle-components analysis, Blatt, Quinlan, Pilkonis, and 
Shea (1995) identified two robust primary factors in the 
DAS: “need for approval” and “perfectionism.” Pretreat-
ment need for approval was not significantly related to out-
come in any of the four TCDRP treatments, however, 
across treatments, high levels of pretreatment perfectionism 
predicted higher depression severity and more impaired 
functioning (GAS and SAS) at termination (Blatt et al., 
1995).   

A subsequent analysis found that the damaging effect 
of perfectionism on treatment outcome was consistent when 
response was measured at both termination and 18-month 
follow-up times and by clinical evaluators, patients, and 
therapists (Blatt, Zuroff, Bondi, Sanislow, & Pilkonis, 
1998). The authors also found a temporal effect for perfec-
tionism; though patients at all levels of perfectionism 
showed improvement from intake to mid-treatment, during 
the second half of treatment patients with moderate to high 
levels of perfectionism ceased improving, whereas those 
with low perfectionism continued to improve. Though the 
negative effects of perfectionism on outcome were seen 
across treatment types and not just in IPT, there is evidence 
that the adverse effects of perfectionism may be mediated 
by patients’ satisfaction with social relationships (Shahar, 
Blatt, Zuroff, Krupnick, & Sotsky, 2004), and thus may be 
particularly relevant to IPT’s focus on relationships. It 
seems that perfectionism contributes to difficulty in estab-
lishing the interpersonal relationships necessary for brief 
therapies such as IPT. However, these findings, all of which 
are based on TDCRP data and operationalize perfectionism 
by the DAS, require further replication. 
 
Personality Disorder 
 

Much research has indicated that patients with person-
ality disorders have poorer and/or slower response to treat-
ment for depression. Using TDCRP data, Shea and col-
leagues (1990) found that subjects with personality disor-
ders, as diagnosed with the Personality Assessment Form 
(PAF) rated pretreatment by clinical evaluators, showed 
less improvement in social functioning at termination. 
Though no significant differences were found in HRSD 
outcome across treatments, there was a trend for subjects 
treated with IPT or imipramine-CM to have a better out-
come when no personality disorder was present. In an ex-
tension of the above analysis, Shahar, Blatt, Zuroff, and 



KEITH 
 

 6 

Pilkonis (2003) found that when personality disorder as 
measured by the PAF was treated as a continuous rather 
than a categorical variable, odd-eccentric cluster personality 
disorders (Cluster A; Paranoid, Schizoid, and Schizotypal) 
predicted worse outcome across treatments.  

Bearden, Lavelle, Buysee, Karp, and Frank (1996) fur-
ther explored the role of personality disorder on IPT re-
sponse in their study of 76 subjects treated with 12 to 20 
sessions of IPT. All subjects had a history of recurrent ma-
jor depression, were currently experiencing a depressive 
episode of probable or definite endogenous subtype, and 
had baseline scores of 15 or above on the HRSD. The au-
thors found that more total DSM-III diagnoses of personal-
ity disorders and more anxious-fearful cluster personality 
disorders (Cluster C; Avoidant, Dependent, and Obsessive-
compulsive), as measured with the SCID Personality Disor-
ders interview, predicted greater time to remission from 
depression (HRSD <= 7 for 3 consecutive weeks). A higher 
number of disordered personality traits and a rating of high 
personality disturbance versus low personality disturbance 
were related to longer time to respond to treatment. Brown, 
Schulberg, and Prigerson (2000) similarly found that pa-
tients receiving IPT who had a current DSM-III Axis II 
personality disorder were significantly less likely to re-
cover.  

Barber and Muenz (1996) provided further insight into 
the role of anxious-fearful personality disorders on response 
to IPT, examining the ways in which Avoidant Personality 
Disorder (AVPD) and Obsessive-Compulsive Personality 
Disorder (OCPD), as measured by the PAF, interacted with 
treatment to affect outcome in TDCRP subjects who re-
ceived CBT or IPT. In accordance with their hypothesis, the 
authors found that IPT was more effective at reducing de-
pression for subjects with OCPD whereas CBT was more 
effective with subjects with AVPD. The authors theorized 
that IPT may be better suited to obsessive patients because 
it uses internal coping strategies to motivate change. 
Avoidant patients who utilize more external coping strate-
gies may not be well suited to IPT.  A limitation in all stud-
ies described above, however, is that personality disorder 
was evaluated during the depressive episode, either at in-
take, or, in the case of Bearden et al. (1996), at four weeks 
into treatment. It is thus difficult to discern the effects of 
depression on personality from true Axis II personality dis-
turbance. 
 
Anxiety 

 
Because depression is often comorbid with anxiety dis-

orders, the influence of anxiety on response to treatment for 
depression is important to consider. Brown, Schulberg, 
Madonia, Shear, and Houck (1996) explored the role of 
lifetime anxiety disorders as measured by the Diagnostic 
Interview Schedule (DIS). Patients with a lifetime anxiety 
disorder presented with greater severity of depression, were 
more likely to drop out of the study, and showed less im-
provement over eight months when treated with either IPT 

or nortriptyline. Patients with depression alone, compared 
to patients with depression and anxiety, showed greater and 
more rapid reduction in symptoms, especially between in-
take and month four. Patients with comorbid anxiety tended 
to take twice as long to show similar reductions in depres-
sion severity. Looking at rates of full recovery (defined as 
HRSD <= 7), the researchers observed that IPT subjects 
with depression alone or with depression and lifetime gen-
eralized anxiety disorder were more likely to have recov-
ered at four and eight months than subjects with depression 
and a lifetime panic disorder. These differences were not 
observed in the nortriptyline group. Feske et al. (1998) pro-
vided further evidence for the deleterious effect of anxiety 
disorders, and panic disorder in particular, on response to 
IPT. In their study of women with recurrent unipolar de-
pression, treatment non-remitters (defined as HRSD >= 7 
for 3 consecutive weeks) had significantly higher levels of 
somatic anxiety (measured by the HRSD) and were more 
likely to meet lifetime criteria for panic disorder (measured 
by the SADS or SCID) compared to treatment remitters. 
Total anxiety level as reported on the SADS and psychic 
anxiety as reported on the HRSD did not differentiate be-
tween remitters and non-remitters. It appears that IPT may 
effectively treat depression with some comorbid anxiety 
unless this anxiety is of a more somatic nature, as in panic 
disorder, in which case IPT is not as effective and pharma-
cotherapy may be warranted. 
 
Expectations of Improvement 

 
A final patient characteristic that has been studied as a 

predictor of response to treatment for depression, including 
IPT, is expectation of improvement. Across many types of 
psychotherapy, patients’ expectations of improvement from 
treatment have been shown to be powerful predictors of 
outcome (reviewed in Meyer et al., 2002). Indeed, one of 
the ways in which IPT therapists may help patients recover 
from depression is by helping to increase expectations of 
treatment success by explicitly indicating that the outlook 
for recovery is good (Weissman et al., 2000). Findings from 
the TDCRP support the role of patient expectations in out-
come (Meyer et al., 2002; Sotsky et al., 1991). Treatment 
expectancy in the TDCRP was assessed via a one-item 
measure administered at intake asking patients to rate their 
expectation of their outcome. Patient global expectancies, 
defined as status in one year assuming no other treatment, 
were also assessed with one item at intake. Researchers 
found that patient treatment expectations significantly pre-
dicted full recovery and reduction of depression symptoms 
across treatments with a medium effect size. Patient global 
expectancies, however, were not correlated with outcome 
(Meyer et al., 2002; Sotsky et al., 1991). A separate study 
conducted during the training of IPT therapists for the 
TDCRP found that negative patient expectations of out-
come were correlated with greater hostile, defensive, and 
help-rejecting attitudes among patients, which in turn im-
peded therapists’ ability to effectively administer IPT 



PATIENT PREDICTORS OF RESPONSE TO IPT 
 

 7

(Foley, O’Malley, Rounsaville, Prusoff, & Weissman, 
1987). This study provides support for the effects of patient 
expectations for outcome in IPT in particular. Perhaps re-
lated to expectations of outcome, Brown, Schulberg, and 
Prigerson (2002) found that patients who perceived more 
internal control over their health responded significantly 
better to IPT. 
 

The Role of the Therapeutic Alliance 
  

The therapeutic alliance is widely acknowledged as a 
key ingredient in effective psychotherapy across treatment 
types. In the TDCRP, stronger therapeutic alliances in early 
sessions and across all sessions, as measured variously by 
the evaluator-rated Vanderbilt Therapeutic Alliance Scale 
(VTAS) and the patient-report Barrett-Lennard Relation-
ship Inventory (B-L RL), were strongly associated with less 
attrition and greater improvement in all treatment groups. In 
fact, more variance in outcome was attributable to the alli-
ance than to the treatment method (Krupnick et al., 1996; 
Blatt, Zuroff, Quinlan, & Pilkonis, 1996).   

Given the crucial role of the alliance on therapeutic 
outcome, it is not surprising that the alliance has been found 
to mediate and moderate several key patient predictors of 
response to treatment. For example, Meyer et al. (2002) 
found that the strength of the therapeutic alliance (as meas-
ured by the VTAS) appeared to mediate the relationship 
between patients’ expectations and treatment outcome 
across treatments in the TDCRP. Patients with higher ex-
pectations of treatment outcome tended to develop stronger 
relationships with their therapists, which in turn led to a 
better outcome. Investigating the effect of perfectionism on 
the therapeutic relationship across treatments in the 
TDCRP, Zuroff and colleagues (2001) observed that the 
negative relationship between perfectionism and treatment 
response was partially mediated by the failure of perfection-
ists to develop stronger therapeutic alliances (measured by 
the VTAS) as therapy progressed. Blatt, Zuroff, et al. 
(1996) further noted that though quality of therapeutic rela-
tionship (measured by the B-L RL) was unrelated to out-
come for patients with either very high or very low levels of 
perfectionism, it was associated with outcome for patients 
with moderate levels of perfectionism. In other words, for 
somewhat perfectionistic patients, a positive therapeutic 
relationship moderates the negative effects of perfectionism 
and helps to predict a better outcome. As seen in these pre-
liminary studies of perfectionism and expectations of out-
come, a patient’s contribution to the therapeutic alliance 
may be one of the pathways through which patient charac-
teristics affect outcome of treatment. 
 

Clinical Applications and 
Directions for Future Research 

 
This review has found evidence in the literature of sev-

eral patient moderators of response to IPT for depression. 

Examining the data presented here, a profile of patients who 
may respond better to IPT emerges. It appears that to re-
spond optimally to IPT as a treatment for depression, a pa-
tient should have a duration of the current episode of less 
than 6 months; a normal sleep profile; some minimum level 
of social functioning; an adult attachment style other than 
fearful-avoidant; less characterological perfectionism; lack 
of a personality disorder; lack of somatic anxiety symptoms 
or a lifetime diagnosis of panic disorder; positive expecta-
tions for the outcome of treatment; and more perceived in-
ternal control over health. Some of these characteristics, 
such as somatic anxiety and social functioning, appear to be 
specific factors affecting response to IPT in particular. Oth-
ers, such as perfectionism and treatment expectations, are 
non-specific predictors of response across several types of 
treatment that have been shown to apply to IPT. Both spe-
cific and non-specific factors are important to consider in 
determining patients’ likelihood to respond to IPT. Of addi-
tional importance in making treatment decisions are factors 
that have been found to differentiate IPT’s effectiveness 
from that of other treatment options, including more severe 
depression (IPT may be better than clinical management 
alone); atypical depression (IPT may be better than phar-
macotherapy); divorced or separated marital status (IPT 
may be better than CBT); and presence of Obsessive Com-
pulsive Personality Disorder (IPT may be better than CBT). 
Of note, several variables seem consistently unrelated to 
IPT outcome, including age, gender, age of onset of first 
depressive episode, and number of previous depressive epi-
sodes (Brown, Schulberg, & Prigerson, 2000; Feske et al., 
1998; Sotsky et al., 1991). 

The clinical applicability of these findings in determin-
ing the “goodness of fit” for IPT and increasing particularly 
effective aspects of IPT (e.g., by further encouraging posi-
tive expectations of treatment outcome) is promising; how-
ever, more research in this area is needed. The research to 
date is limited by its dependence on one study, the TDCRP, 
for most results, with few findings replicated outside of this 
sample. The TDCRP was a well-designed study using 
highly trained, experienced therapists to deliver treatment. 
It is unknown whether predictors of response in the TDCRP 
would extend to IPT conducted by less experienced thera-
pists in a less structured setting. It is noteworthy that the 
findings of other studies (e.g., Brown, Schulberg, & Priger-
son, 2000; Feske et al., 1998) seem to conflict with the 
TDCRP findings in several respects. These contradictory 
findings may be due to differing populations studied, meas-
ures used, and/or definitions of response used; this requires 
further research. Additionally, the findings regarding non-
specific predictors of response (e.g. perfectionism) require 
replication with studies addressing IPT treatment in particu-
lar. 

The role of therapist characteristics in predicting re-
sponse to IPT, alone and in interaction with patient vari-
ables, is another avenue for future research, especially in 
light of findings regarding the key role of the therapeutic 
alliance in predicting response to treatment. As yet there is 



KEITH 
 

 8 

little data in this regard. However, preliminary research 
across TDCRP groups indicates that more effective thera-
pists are not ones with more experience but rather with 
more psychological as opposed to biological orientations to 
the clinical process (e.g., they tended to favor psychother-
apy over biological interventions for the treatment of de-
pression) (Blatt, Sanislow, Zuroff, & Pilkonis, 1996). The 
implications of this finding for IPT have not yet been ad-
dressed. In conclusion, though some knowledge has been 
accumulated about patient predictors of response to IPT for 
depression, more research is needed to replicate and extend 
current findings. Additional research is also needed to focus 
on other potential predictors of response and on the interac-
tion of established predictors with therapist and treatment 
variables. 

 
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Treatment outcome in recurrent major depression: A 



PATIENT PREDICTORS OF RESPONSE TO IPT 
 

 9

post hoc comparison of elderly (“young old”) and mid-
life patients. American Journal of Psychiatry, 153, 1288-
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Shahar, G., Blatt, S. J., Zuroff, D. C., Krupnick, J. L., Sot-
sky, S. M. (2004). Perfectionism impedes social relations 
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(2003). Role of perfectionism and personality disorder 
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Collins, J. F., Elkin, I., et al. (1991). Patient predictors of 

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pressed patients will respond to interpersonal psycho-
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brief outpatient treatment of depression. Journal of Con-
sulting and Clinical Psychology, 68, 114-124.

 

 


	Overview of Studies Reviewed
	Key Patient Predictors of IPT Response
	Features of Depression
	Social Functioning

	Personality Disorder
	Anxiety
	Expectations of Improvement


