The perils of perfection: A prospective population-based cohort study of perfectionism and depression in young adults

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OBJECTIVE: Perfectionism is a multidimensional vulnerability factor for depression in young adults, particularly in academic settings. This study examined whether Self-Oriented Perfectionism (SOP) and Socially Prescribed Perfectionism (SPP), used as indicators conceptually aligned with perfectionistic strivings and concerns, were prospectively associated with current major depressive episode (MDE) among higher education students. PARTICIPANTS: Participants were 10,460 university and college students aged 18-35 years from the national Norwegian SHOT2022 survey who completed a self-administered diagnostic follow-up approximately one year later. METHODS: Perfectionism was assessed in 2022 using the Eating Disorder Inventory Perfectionism subscale. Current MDE was assessed in 2023 using a self-administered computerized version of the Composite International Diagnostic Interview (CIDI 5.0), based on DSM-5 criteria. Associations were examined using sex-stratified logistic regression models. Linear, quadratic, and restricted cubic spline models were compared to evaluate non-linear associations. RESULTS: Current MDE was present in 17.0% of women and 10.8% of men. Higher SOP and SPP scores were associated with higher prevalence of current MDE at follow-up. Linear ORs per 1-point increase ranged from 1.13 to 1.16 for SOP and SPP across sexes. Model comparisons supported non-linear associations. Estimated MDE prevalence was lowest at low-to-moderate perfectionism scores and increased at the upper end of the score distributions, reaching approximately 40% for SOP and SPP among women and approximately 30% among men. CONCLUSIONS: EDI-P perfectionism scores were prospectively associated with current MDE in a non-linear manner. Findings support nuanced prevention and clinical approaches to perfectionism among higher education students.

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