Clinical characteristics of outpatients with chronic major depression

Mental Health Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 05/1995; 34(1):25-32. DOI: 10.1016/0165-0327(94)00101-E
Source: PubMed


A cross-sectional evaluation of 243 unipolar, nonpsychotic outpatients with major depression was conducted. All subjects were diagnosed by RDC with SADS-L structured interviews. Diagnoses included RDC primary/secondary, RDC endogenous/nonendogenous and Winokur's family-history subtypes. Symptom severity was assessed by the 17-item Hamilton Rating Scale for Depression. Chronic depression was defined as the current episode of major depression lasting at least 2 years, corresponding to DSM-III-R and -IV criteria. Patients with chronic depression (n = 64) were compared with those with nonchronic depression (n = 179). Chronicity was not related to gender, symptom severity, prior length of illness, age at onset of illness, RDC endogenous/nonendogenous, RDC primary/secondary or Winokur's family-history subtypes. Those with chronic depression were older and had fewer major depressive episodes than the nonchronic group. That the chronic group had fewer total episodes of depression than the nonchronic group, but a similar age at onset, is consistent with the notion that patients in a current chronic episode have characteristically longer depressive episodes throughout the course of their illness. Those with chronic episodes may be subject to psychological, biological and/or sociocultural factors that preclude an earlier episode remission for these individuals.

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    • "Fig. 1 There is extensive literature on the risk factors for CMDD, that overall converges in suggesting a limited number of risk factors related to MDD (Holzel et al., 2011; Rhebergen et al., 2012; Riedel et al., 2011). CMDD has been most often associated to earlier age of onset, family history of mood disorders, lower socioeconomic status, co-occurrence of other mental disorders, lower level of quality of life, longer delays to the first treatment-seeking for MDD, and greater number of stressful life events (Angst et al., 2009; Friis et al., 2002; Gilmer et al., 2005; Hays et al., 1997; Holzel et al., 2011; Klein et al., 2004; Mueller et al., 1996; Nakanishi et al., 1993; Rush et al., 1995; Spijker et al., 2002). Although these studies have advanced our knowledge of CMDD, they have been constrained by their cross-sectional design, which has limited their ability to draw causal inferences, or their reliance on clinical samples, which has limited the generalizability of their findings. "
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    ABSTRACT: Chronic major depressive disorder (CMDD) is highly prevalent and associated with high personal and societal cost. Identifying risk factors for persistence and remission of CMDD may help in developing more effective treatment and prevention interventions. Prospective cohort study of individuals participating in the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1; n=43,093) and its 3-year follow-up (Wave 2; n=34,653) who met a diagnosis of CMDD at the Wave 1 assessment. Among the 504 respondents who met criteria for present CMDD at Wave 1, only 63 (11.52%) of them continued to meet criteria of CMDD. A history of childhood sexual abuse, earlier onset of MDD, presence of comorbidity and a history of treatment-seeking for depression predicted persistence of CMDD three years after the baseline evaluation. Our sample is limited to adults, our follow-up period was only three-years and the diagnosis of CMDD at baseline was retrospective. CMDD shows high rates of remission within three years of baseline assessment, although some specific risk factors predict a persistent course. Given the high personal and societal cost associated with CMDD, there is a need to develop and disseminate effective interventions for CMDD.
    Journal of Affective Disorders 07/2013; 151(1). DOI:10.1016/j.jad.2013.06.013 · 3.38 Impact Factor
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    • "In keeping with the findings of others (Gilmer et al., 2005; Rush et al., 1995), we found that older current age was associated with increased risk of lifetime chronic depression. "
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    ABSTRACT: The draft proposal to add Chronic Depressive Disorder to DSM-5 will combine DSM-IV Dysthymic Disorder and Major Depressive Disorder, with chronic specifier, into a single diagnosis. The objective of this study is to estimate the prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder using unit record data from the 2007 Australian National Survey of Mental Health and Wellbeing. Secondary analysis of a nationally representative household survey. Urban and rural census tracts. One individual between the ages of 16 and 85 years from 8841 households was interviewed for the survey. Lifetime prevalence estimates for chronic and non-chronic depression were determined using data from the World Health Organization's Composite International Diagnostic Interview, version 3.0 (WMH-CIDI 3.0). Chronic depression of at least two years' duration had a lifetime prevalence of 4.6% (95% CI: 3.9-5.3%) and was found in 29.4% (95% CI: 25.6-33.3%) of individuals with a lifetime depressive disorder. Higher rates of psychiatric co-morbidity (OR=1.42; 95% CI=1.26-1.61), older age (OR=1.04; 95% CI=1.02-1.05), a younger age of onset (OR=0.97; 95% CI=0.95-0.98) and more frequent episodes of depression (OR=1.75; 95% CI=1.07-2.86) were found to be significant correlates of chronic depression. The first episode of depression for individuals with chronic depression often developed after the death of someone close (OR=2.38; 95% CI 1.16-5.79). Chronic depression is highly prevalent among community-residing persons and has a set of correlates that discriminate it from non-chronic depression. The distinction between chronic and non-chronic depression proposed for DSM-5, in the form of Chronic Depressive Disorder, seems to be warranted.
    Journal of Affective Disorders 02/2012; 139(2):172-80. DOI:10.1016/j.jad.2012.01.033 · 3.38 Impact Factor
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    • "High neuroticism scores are robustly associated with an increased risk for depression (Angst and Clayton, 1986; Hirschfeld et al., 1989; Kendell and DiScipio, 1968; Kendler et al., 1993; Wetzel et al., 1980), and experience of a depressive episode yields an elevation in neuroticism which persists after post-recovery (i.e., a scar effect) (Reich et al., 1987). Neuroticism is known to be a strong risk factor for the lifetime prevalence of major depressive disorder (MDD) (Alnaes and Torgersen, 1997; Hirschfeld et al., 1989; Roberts and Kendler, 1999; Rush et al., 1995). "
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    ABSTRACT: The personality trait of neuroticism is a risk factor for major depressive disorder (MDD), but this relationship has not been demonstrated in clinical samples from Asia. We examined a large-scale clinical study of Chinese Han women with recurrent major depression and community-acquired controls. Elevated levels of neuroticism increased the risk for lifetime MDD (with an odds ratio of 1.37 per SD), contributed to the comorbidity of MDD with anxiety disorders, and predicted the onset and severity of MDD. Our findings largely replicate those obtained in clinical populations in Europe and US but differ in two ways: we did not find a relationship between melancholia and neuroticism; we found lower mean scores for neuroticism (3.6 in our community control sample). Our findings do not apply to MDD in community-acquired samples and may be limited to Han Chinese women. It is not possible to determine whether the association between neuroticism and MDD reflects a causal relationship. Neuroticism acts as a risk factor for MDD in Chinese women, as it does in the West and may particularly predispose to comorbidity with anxiety disorders. Cultural factors may have an important effect on its measurement.
    Journal of Affective Disorders 08/2011; 135(1-3):100-5. DOI:10.1016/j.jad.2011.06.053 · 3.38 Impact Factor
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