According to the cognitive theory, negative automatic thoughts (NAT) and dysfunctional attitudes (DA) are important causal factors for the onset and maintanence of depression. There is limited data on the effects of NATs and DAs on the recurrence of depressive episodes. This study aims to compare the NATs and DAs of first versus recurrent episode depressive patients. The hypothesis of the study is that the intensity of negative cognitions will parallel the number of recurrences.

For the study, 100 first episode and 100 recurrent episode major depressive disorder diagnosed outpatients and 100 healthy volunteers presenting to the psychiatry clinics of three hospitals in Turkey were recruited. The participants were diagnosed by MINI, asked to complete the BDI, ATQ and DAS. Statistical analyses were undertaken to predict the variables affecting recurrence.

The groups were not statistically different on sociodemographic variables. The mean NAT and DA scores were highest in the recurrent depression group. Regression analyses for the prediction of recurrence revealed that perfectionistic attitude, severity of depression and number of hospitalizations were the most correlated variables. The number of recurrences was correlated with the perfectionistic attitude scores.

These results show that the NATs and DAs of first episode depression patients differ from those of the recurrent episode depression patients, and the number of recurrences are predicted by perfectionistic attitudes. This has clinical implications in the treatment of depression, particularly points out to the need to manage perfectionistic attitudes to prevent recurrences.