Major depression: the importance of clinical characteristics and treatment response to prognosis

Katon, Wayne; Unützer, Jürgen; Russo, Joan

doi:10.1002/da.20613

Cited by 88 publications

(68 citation statements)

References 32 publications

(67 reference statements)

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“…4 This cohort represents the heterogeneous and variable nature of depression seen in primary care. 11,14 Data are of good quality, with recruitment and attrition rates in the range of those reported in longitudinal studies of depression in primary care. 50,51 Missing data have been dealt with rigorously using multiple imputation methods to overcome possible biases related to complete case analysis.…”

Section: Strengthsmentioning

confidence: 97%

“…8 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. Useful predictors of poor depression outcome in primary care have been identified in 3 main areas: individual characteristics (age, 10 high neuroticism levels, 11 perceived need for care, 12 low mastery 13 ); socioeconomic status (low education level, 12 low income, 12 unemployment 12 ); loneliness, 12 low social support, 12,14 limitations of social activities due to health 14 ; and health, both physical (medical comorbidity, 11,12,14,15 chronic pain, 11 daily smoking 13 ) and mental (comorbid anxiGilles Ambresin, MD 1 ety, 11,12,15 double depression, 11 severity of depressive symptoms, 11,12,14,16 somatic symptoms of depression, 16 history of recurrent depression, 15 remission status at 3 months, 15 appropriate use of antidepressant medications, 14 greater mental dysfunction 16 ). Reliable assessment of the predictors listed above requires time and a multitude of validated instruments.…”

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confidence: 99%

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Self-Rated Health and Long-Term Prognosis of Depression

Ambresin

Chondros

Dowrick

et al. 2014

The Annals of Family Medicine

124

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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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Section: Strengthsmentioning

confidence: 97%

mentioning

confidence: 99%

Self-Rated Health and Long-Term Prognosis of Depression

Ambresin

Chondros

Dowrick

et al. 2014

The Annals of Family Medicine

124

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“…A prevalência de episódios depressivos entre pacientes clínicos com dor é alta (42%) 2 . Pacientes com comorbidade de doenças físicas e depressão apresentam mais dor crônica e têm pior evolução apesar do tratamento adequado 3 . Observou-se que pacientes com artrite, portanto com dor crônica, têm maior predisposição de desenvolver transtornos do humor 4 .…”

Section: Introductionunclassified

Associação entre depressão, níveis de dor e falta de apoio social em pacientes internados em enfermarias de clínica médica

Marques

Stefanello

Mendonça

et al. 2013

J. bras. psiquiatr.

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rESUMo objetivo: Verificar a associação entre depressão, níveis de dor e falta de apoio social em pacientes clínicos internados. Métodos: Em um estudo transversal, 1.147 adultos admitidos nas enfermarias de clínica médica de um hospital universitário foram selecionados por randomização e avaliados durante a primeira semana de internação. Foram utilizados: Subescala Cognitivo-afetiva do Inventário Beck de Depressão (BDI-13), Índice Charlson de Comorbidade Física e escalas numéricas para avaliar dor e percepção de gravidade física. Foram considerados deprimidos os pacientes que pontuaram acima de 10 no BDI-13. Investigou-se apoio social por meio da pergunta direta: "Com quantos parentes ou amigos você se sente à vontade e pode falar sobre tudo ou quase tudo?". Foram considerados como tendo falta de apoio social os pacientes que relataram ter menos que quatro parentes ou amigos confidentes. aBStraCt objective:To evaluate the association of depression, levels of pain and lack of social support in medical inpatients. Methods: In a cross sectional observational study, 1,147 adults admitted to the general medical wards of a university hospital were randomized and evaluated during the first week of admission. The following instruments were used: cognitive--affective subscale of the Beck Depression Inventory (BDI-13), Charlson Comorbidity Index and numerical scales to evaluate pain and perception of medical burden. Patients who scored > 10 in the BDI-13 were considered depressed. Social support was investigated asking the

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“…Depression results in more years lived with a disability compared with any other disease, and also carries increased risks of suicide, medical comorbidities, and family caregiver burden (Casten et al, 1999;Garcia-Pena et al, 2013;Katon et al, 2010;Mulsant et al, 2006;Nelson et al, 2013). Unfortunately, LLD has a high treatment failure rate (ie 40-60%) with current first-line agents (Lebowitz et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

White Matter Hyperintensity Accumulation During Treatment of Late-Life Depression

Khalaf

Edelman

Tudorascu

et al. 2015

Neuropsychopharmacol

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White matter hyperintensities (WMHs) have been shown to be associated with the development of late-life depression (LLD) and eventual treatment outcomes. This study sought to investigate longitudinal WMH changes in patients with LLD during a 12-week antidepressant treatment course. Forty-seven depressed elderly patients were included in this analysis. All depressed subjects started pharmacological treatment for depression shortly after a baseline magnetic resonance imaging (MRI) scan. At 12 weeks, patients underwent a follow-up MRI scan, and were categorized as either treatment remitters (n = 23) or non-remitters (n = 24). Among all patients, there was as a significant increase in WMHs over 12 weeks (t(46) = 2.36, P = 0.02). When patients were stratified by remission status, non-remitters demonstrated a significant increase in WMHs (t(23) = 2.17, P = 0.04), but this was not observed in remitters (t(22) = 1.09, P = 0.29). Other markers of brain integrity were also investigated including whole brain gray matter volume, hippocampal volume, and fractional anisotropy. No significant differences were observed in any of these markers during treatment, including when patients were stratified based on remission status. These results add to existing literature showing the association between WMH accumulation and LLD treatment outcomes. Moreover, this is the first study to demonstrate similar findings over a short interval (ie 12 weeks), which corresponds to the typical length of an antidepressant trial. These findings serve to highlight the acute interplay of cerebrovascular ischemic disease and LLD.

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Major depression: the importance of clinical characteristics and treatment response to prognosis

Abstract: Patients with higher levels of depression severity had worse clinical outcomes despite receiving greater intensity of treatment. A new classification of depression is proposed based on clinical severity, course of illness and treatment experience.

Cited by 88 publications

References 32 publications

Self-Rated Health and Long-Term Prognosis of Depression

Self-Rated Health and Long-Term Prognosis of Depression

Associação entre depressão, níveis de dor e falta de apoio social em pacientes internados em enfermarias de clínica médica

White Matter Hyperintensity Accumulation During Treatment of Late-Life Depression

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