Performance-Based Personality Functioning and Long-Term Outcome in Hospitalized Women with Depression: A Four-Year Follow-Up

Background: Depression is among the most prevalent psychiatric conditions and markedly disrupts everyday functioning. Its origins are multifactorial, with biological, psychological, and contextual influences jointly shaping the course of recovery and the response to treatment. Personality has been proposed as a relatively stable factor that may reflect developmental influences on emotional and cognitive functioning and may be associated with long-term clinical outcomes in depression. The present study aimed to examine the association between implicit personality characteristics in women hospitalized for depressive disorder and their long-term psychosocial functioning, using a performance-based measure of personality (the Rorschach Inkblot Method, RIM). Subjects and Methods: At baseline (T1), 58 women hospitalized for depressive disorder completed the Beck Depression Inventory (BDI-II) and the Rorschach Inkblot Method (RIM); Rorschach protocols were scored using the Ego Impairment Index—second revision (EII-2), a behaviorally derived index spanning perceptual accuracy, executive integrity, and social cognition. Demographic and clinical information was abstracted from medical records, and an independent rating of functioning was obtained with the Global Assessment of Functioning scale (GAF). Four years later (T2), patients were re-administered the BDI-II and the GAF, and major life events occurring during the follow-up interval were quantified with the Social Readjustment Rating Scale (SRRS). Results: Baseline implicit personality organization showed a significant association with psychosocial functioning four years after the index hospitalization. Among the variables examined, personality structure at admission outperformed both initial depressive symptom severity and the burden of intervening life events in predicting later functional status. In particular, EII-2 accounted for an additional 10.3% of the variance (ΔR2 = 0.103, p < 0.05) over and above age, chronicity, stress, and depressive symptom severity when predicting four-year GAF-rated functioning. Among the predictors examined, age was the most influential variable in the final model (β = 0.442), indicating that demographic factors carry substantial weight alongside personality functioning in shaping long-term outcomes. Conclusions: Our findings are consistent with the view that a patient’s personality may influence the course of recovery and suggest that personality-level factors deserve attention when planning care for this clinically complex disorder. The present results indicate that implicit cognitive–perceptual features—assessed through performance-based methods that bypass conscious self-report—may be associated with long-term psychosocial functioning in women hospitalized for depression. These findings suggest that performance-based personality assessment deserves further study as a potential prognostic aid, although replication in larger and more diverse samples is needed before clinical application.