Prevalence and predictors of recurrence of major depressive disorder in the adult population

De Gelderse Roos, Institute for Mental Health Care, Ede, The Netherlands.
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 12/2009; 122(3):184-91. DOI: 10.1111/j.1600-0447.2009.01519.x
Source: PubMed


Knowledge of the risk of recurrence after recovery of a major depressive disorder (MDD) is of clinical and scientific importance. The purpose of this paper was to provide a systematic review of the prevalence and predictors of recurrence of MDD.
Studies were searched in Medline en PsychINFO using the search terms 'recur*', 'relaps*', 'depress*', 'predict*' and course.
Recurrence of MDD in specialised mental healthcare settings is high (60% after 5 years, 67% after 10 years and 85% after 15 years) and seems lower in the general population (35% after 15 years). Number of previous episodes and subclinical residual symptoms appear to be the most important predictors. Gender, civil status and socioeconomic status seem not related to the recurrence of MDD.
Clinical factors seem the most important predictors of recurrence. Data from studies performed in the general population and primary care on the recurrent course of MDD are scarce.

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    • "Dysthymic disorder is often considered more chronic in nature, but over long follow-up periods, recovery rates resemble those of MDD. However, despite the chronic and recurrent course of illness for many patients, it has been estimated that about half of the individuals diagnosed with major depressive disorder recover and do not develop recurrent episodes (Eaton et al., 2008, Hardeveld et al., 2010). "
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    ABSTRACT: Background: Depressive disorders are among the most pressing public health challenges worldwide. Yet, not enough is known about their long-term outcomes. This study examines the course and predictors of different outcomes of depressive disorders in an eleven-year follow-up of a general population sample. Methods: In a nationally representative sample of Finns aged 30 and over (BRIF8901), major depressive disorder (MDD) and dysthymia were diagnosed with the Composite International Diagnostic Interview (M-CIDI) in 2000. The participants were followed up in 2011 (n=5733). Outcome measures were diagnostic status, mortality, depressive symptoms and health-related quality of life. Multiple imputation (MI) was used to account for nonresponse. Results: At follow-up, 33.8% of persons with baseline MDD and 42.6% with baseline dysthymia received a diagnosis of depressive, anxiety or alcohol use disorder. Baseline severity of disorder, measured by the Beck Depression Inventory, predicted both persistence of depressive disorder and increased mortality risk. In addition, being never-married, separated or widowed predicted persistence of depressive disorders, whereas somatic and psychiatric comorbidity, childhood adversities and lower social capital did not. Those who received no psychiatric diagnosis at follow-up still had residual symptoms and lower quality of life. Limitations: We only had one follow-up point at eleven years, and did not collect information on the subjects' health during the follow-up period. Conclusions: Depressive disorders in the general population are associated with multiple negative outcomes. Severity of index episode is the strongest predictor of negative outcomes. More emphasis should be placed on addressing the long-term consequences of depression.
    Journal of Affective Disorders 11/2015; 190. DOI:10.1016/j.jad.2015.10.043 · 3.38 Impact Factor
    • "Patients whose follow-up data were unavailable or who did not experience a relapse/recurrence before the end of the follow-up period were treated as censored observations. Regression analyses were performed with and without adjustment for depressive symptoms at baseline and number of depressive episodes in the past (log transformed), factors known to predict relapse/recurrence (Hardeveld et al., 2010). As there were no effects of research site on relapse/recurrence, we did not include site in our statistical models. "
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    ABSTRACT: Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied. Our aim was to investigate whether the addition of MBCT to mADM is a more effective prevention strategy than mADM alone. This study is one of two multicenter randomised trials comparing the combination of MBCT and mADM to either intervention on its own. In the current trial, recurrently depressed patients in remission who had been using mADM for 6 months or longer (n=68), were randomly allocated to either MBCT+mADM (n=33) or mADM alone (n=35). Primary outcome was depressive relapse/recurrence within 15 months. Key secondary outcomes were time to relapse/recurrence and depression severity. Analyses were based on intention-to-treat. There were no significant differences between the groups on any of the outcome measures. The current study included patients who had recovered from depression with mADM and who preferred the certainty of continuing medication to the possibility of participating in MBCT. Lower expectations of mindfulness in the current trial, compared with the parallel trial, may have caused selection bias. In addition, recruitment was hampered by the increasing availability of MBCT in the Netherlands, and even about a quarter of participants included in the trial who were allocated to the control group chose to get MBCT elsewhere. For this selection of recurrently depressed patients in remission and using mADM for 6 months or longer, MBCT did not further reduce their risk for relapse/recurrence or their (residual) depressive symptoms. Copyright © 2015 Elsevier B.V. All rights reserved.
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    • "In addition to RTW, sustained RTW or return to work in good health (MDD in remission) may be relevant outcomes both from a health and an economic perspective. This holds in particular for MDD, because of its long-term course with different levels of residual or subclinical symptoms, a high rate of recurrence (ten Doesschate et al., 2010; Hardeveld et al., 2010) and sickness absence Endo et al. (2012). However, studies focusing on these outcomes are scarce (Hees et al., 2013, 2012; Virtanen et al., 2011; Arends et al., 2014). "
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    Journal of Affective Disorders 07/2015; 185:180-187. DOI:10.1016/j.jad.2015.07.013 · 3.38 Impact Factor
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