{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T05:49:08Z","timestamp":1774590548694,"version":"3.50.1"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PCN Reports"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Avoidance is a key maintaining factor in major depressive disorder (MDD); however, longitudinal evidence remains limited, and its association with personality traits is not fully understood. This study aimed to (1) examine the longitudinal associations among avoidance, depressive symptoms, and rumination and (2) explore the relationship between avoidance and personality traits in outpatients with MDD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this 10\u2010month prospective study, 53 adult outpatients diagnosed with MDD were assessed while receiving routine outpatient psychiatric care. Avoidance, depressive symptoms, and rumination were measured at baseline and follow\u2010up using the Cognitive Behavioral Avoidance Scale (CBAS), 17\u2010item GRID\u2010Hamilton Depression Rating Scale (GRID\u2010HAMD\u201017), and Ruminative Responses Scale (RRS), respectively. Personality traits were assessed at baseline using the Temperament and Personality Questionnaire (T&amp;P). Patients were dichotomized into an Avoidance Improvement (AI) group (\u22659\u2010point reduction in CBAS scores) or a Non\u2010Avoidance Improvement (NON\u2010AI) group based on a median split. Univariate and multivariate regression analyses were conducted to identify factors associated with Avoidance Improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The AI group demonstrated greater reductions in depressive symptoms (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and rumination (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031) than the NON\u2010AI group. In multivariate analysis, greater improvement in depressive symptoms (odds ratio [OR]\u2009=\u20091.130, 95% confidence interval [CI]\u2009=\u20091.016\u20131.257) and lower baseline Personal Reserve (OR\u2009=\u20090.848, 95% CI\u2009=\u20090.724\u20130.968) were independently associated with improvement in avoidance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reductions in depressive symptoms and lower Personal Reserve may contribute to decreased avoidance in MDD. These findings highlight the importance of targeting depressive symptoms not only for direct relief but also to disrupt maladaptive avoidance cycles.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pcn5.70288","type":"journal-article","created":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T15:06:04Z","timestamp":1768748764000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improvement in avoidance in major depressive disorder: A 10\u2010month prospective study of depressive symptoms and personality traits"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9730-7988","authenticated-orcid":false,"given":"Ryotaro","family":"Higuchi","sequence":"first","affiliation":[{"name":"Department of Neuropsychiatry St. Marianna School of Medicine Kawasaki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2294-2571","authenticated-orcid":false,"given":"Atsuo","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry St. Marianna School of Medicine Kawasaki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dai","family":"Mitsuda","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry St. Marianna School of Medicine Kawasaki Japan"},{"name":"Department of Neuropsychiatry Keio University School of Medicine Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waka","family":"Nogami","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry St. Marianna School of Medicine Kawasaki Japan"},{"name":"Department of Psychiatry Higashi\u2010Ohmiya Mental Clinic Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mizuki","family":"Amano","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry Keio University School of Medicine Tokyo Japan"},{"name":"Department of Psychiatry Toyosato Hospital Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sakae","family":"Ihara","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry Keio University School of Medicine Tokyo Japan"},{"name":"Department of Psychiatry Higashi\u2010Ohmiya Mental Clinic Saitama Japan"},{"name":"Department of Psychiatry Tokyo Adachi Hospital Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aoi","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry St. Marianna School of Medicine Kawasaki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachiko","family":"Noda","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry Keio University School of Medicine Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nariko","family":"Katayama","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry Keio University School of Medicine Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Kocha","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry St. Marianna School of Medicine Kawasaki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,18]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"World Health Organization. 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