The natural course and outcome of major depressive disorder in primary care: the PREDICT-NL study

Abstract

PurposeTo examine the natural course and outcome of major depressive disorder (MDD) in primary care over 39 months.MethodsProspective cohort study of 1,338 consecutive attendees with follow-up after 6, 12, and 39 months with DSM-IV MDD using the Composite International Diagnostic Interview (CIDI). We measured severity of depressive symptoms (Patient Health Questionnaire 9), somatic symptoms (Patient Health Questionnaire 15), and mental and physical function (Short Form 12, mental and physical component summary). Analysis of variance and random coefficient models were performed.ResultsAt baseline, 174 people (13%) had MDD of which 17% had a chronic and 40% had a fluctuating course, while 43% remitted. Patients with chronic courses had more severe depressive symptoms (mean difference 6.54; 95% CI 4.38–8.70), somatic symptoms (mean difference 3.31; 95% CI 1.61–5.02), and greater mental dysfunction (mean difference −10.49; 95% CI −14.42 to −6.57) at baseline than those who remitted from baseline, independent of age, sex, level of education, presence of a chronic disease, and a lifetime history of depression.ConclusionsAlthough 43% of patients with MDD attending primary care recover, this leaves a majority of patients (57%) who have a chronic or intermittent course. Chronic courses are associated with higher levels of depressive symptoms and somatic symptoms and greater mental dysfunction at baseline.

Use of general practice services 5 years after an episode of mental illness: case–control study using electronic records

“…11,15 The long-term prognosis of depression and anxiety is generally poor, with a substantial proportion of patients not recovering and with many recurrences; the initial severity is an important predictor. [16][17][18][19][20][21][22][23] Regarding the long-term presentation of depression in general practice, it has been reported that about 40% of patients have a recurrence of depression in general practice within a 10-year period. 24, 25 Lloyd et al 26 found relapses or chronic psychiatric conditions after 11 years in one-third of those included with neurotic disorders.…”

Self-Rated Health and Long-Term Prognosis of Depression

“…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.…”

Comorbilidad en personas con depresión que consultan en centros de la atención primaria de salud en Santiago, Chile

“…También se detectó una frecuencia de riesgo suicida superior a 70%, cifra cercana a la reportada en hospitales comunitarios de la X región 24 , pero más alta que la señalada en el extranjero [31][32] . Estos indicadores de compromiso del cuadro clínico son predictores de mala respuesta y recurrencia/cronicidad 27,28,33,34 , y parecieran influirse recíprocamente en pacientes depresivos de APS 31,32 .…”