PURPOSE Indicators of prognosis should be considered to fully inform clinical decision making in the treatment of depression. This study examines whether self-rated health predicts long-term depression outcomes in primary care. METHODSOur analysis was based on the first 5 years of a prospective 10-year cohort study underway since January 2005 conducted in 30 randomly selected Australian primary care practices. Participants were 789 adult patients with a history of depressive symptoms. Main outcome measures include risks, risk differences, and risk ratios of major depressive syndrome (MDS) on the Patient Health Questionnaire.RESULTS Retention rates during the 5 years were 660 (84%), 586 (74%), 560 (71%), 533 (68%), and 517 (66%). At baseline, MDS was present in 27% (95% CI, 23%-30%). Cross-sectional analysis of baseline data showed participants reporting poor or fair self-rated health had greater odds of chronic illness, MDS, and lower socioeconomic status than those reporting good to excellent self-rated health. For participants rating their health as poor to fair compared with those rating it good to excellent, risk ratios of MDS were 2.10 (95% CI, 1.60-2.76), 2.38 (95% CI, 1.77-3.20), 2.22 (95% CI, 1.70-2.89), 1.73 (95% CI, 1.30-2.28), and 2.15 (95% CI, 1.59-2.90) at 1, 2, 3, 4, and 5 years, after accounting for missing data using multiple imputation. After adjusting for age, sex, multimorbidity, and depression status and severity, self-rated health remained a predictor of MDS up to 5 years.CONCLUSIONS Self-rated health offers family physicians an efficient and simple way to identify patients at risk of poor long-term depression outcomes and to inform therapeutic decision making. INTRODUCTIOND epression is the largest contributor to the burden of disease in high-income countries, and further increases are expected.1,2 Of those who seek professional help for depression, 80% turn to a primary care physician. 3 The high prevalence of depressive symptoms in primary care patients highlights the crucial role of primary care in the detection and treatment of depression. 4,5 In clinical practice understanding the prognosis for an individual is central to fully inform treatment decisions, 6 yet prognosis has received limited attention compared with therapeutic and etiological research. 6,7 Validated prognostic indices provide estimates of the probability of an outcome for those with a particular condition 7 and offer improved accuracy in prognostic assumptions that influence clinical decisions. The accuracy of family physicians in predicting the course of depression is described as fair, 9 although as in other conditions it has been studied relatively little. Self-rated health may be a candidate for a simple and transportable prognostic index. It provides a singlequestion assessment of one's subjective health, encompassing physical functioning, as well as psychosocial aspects of health.25,26 Self-rated health has been used as a reliable, quick assessment for population health monitoring. [27][28][29] Two lar...

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