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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    • "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.
    Journal of Affective Disorders 08/2015; 187:54-61. DOI:10.1016/j.jad.2015.08.023 · 3.38 Impact Factor
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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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    ABSTRACT: This study aims to (i) assess work functioning in employees returning to work with a major depression in remission, (ii) study the predictors of impaired work functioning. Participants diagnosed with major depressive disorder (MDD), on long term sick leave (mean 27 weeks) and treated in a specialized mental healthcare setting, were selected from an intervention study sample. They were eligible for this study if they were remitted from their depression and had returned to work for at least 50% of their contract hours at 18 month follow-up. Work functioning was assessed with the Work Limitations Questionnaire (WLQ) and the Need For Recovery scale (NFR). Potential predictors of impaired work functioning were demographic characteristics (assessed at baseline), health characteristics (assessed at baseline, six and twelve month follow-up), and personality- and work characteristics (assessed at 18 month follow-up). After their return to work with MDD in remission, employees were on average still impaired in their work functioning. Personality characteristics were the strongest predictor of this impaired work functioning, followed by health and work characteristics. In the final prediction model, only a passive reaction coping style remained as predictor. We used self-report data with respect to work functioning and work characteristics and not an assessment by a supervisor. Personality trait, coping style, and ability to manage the work environment should be addressed in mental health and return-to-work interventions. Subsequent improved work functioning may be beneficial for mental health and may reduce societal costs. Copyright © 2015. Published by Elsevier B.V.
    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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    • "A meta-analysis of studies treating MDD with selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed antidepressant , reported a mean response rate of only 50.1% (Walsh et al., 2002). Over 60% of remitted MDD patients experience a recurrence of symptoms after 5 years and 85% after 15 years when treated in specialized mental health settings (Hardeveld, Spijker, De Graaf, Nolen, & Beekman, 2010). Consequently, there remains a need for treatments for MDD that will not only improve remission rates, but also decrease recurrence. "
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    ABSTRACT: Insomnia and depression are highly comorbid conditions that show a complex, bidirectional relationship. This study examined whether cognitive-behavioral therapy for insomnia (CBT-I) delivered by a therapist compared with self-help CBT-I (written materials only) reduces insomnia and depression severity in individuals with comorbid insomnia and depression. A total of 41 participants (18-64 years; 25 females) with comorbid depression and insomnia, treated with antidepressants for at least 6 weeks, were randomized to receive 4 sessions of either CBT-I or self-help CBT-I over 8 weeks. Insomnia (Insomnia Severity Index [ISI]) and depression (Beck Depression Inventory-II [BDI-II]) were assessed at baseline, following each session, and at 3-month follow-up. Secondary outcomes were sleep quality and duration (actigraphy and diaries), anxiety, fatigue, and daytime sleepiness. Compared with self-help CBT-I, BDI-II scores in the CBT-I group dropped by 11.93 (95% confidence interval [CI] [6.60, 17.27], p < .001) more points, and ISI scores dropped by 6.59 (95% CI [3.04, 10.15], p = .001) more points across treatment. At 3-month follow-up, 61.1% of CBT-I participants were in clinical remission from their insomnia and depression, compared with 5.6% of the self-help group. CBT-I administered by a therapist produced significant reductions in both insomnia and depression severity posttreatment and at follow-up, compared with a control condition in which participants received only written CBT-I material. Targeting insomnia through CBT-I is efficacious for treating comorbid insomnia and depression, and should be considered an important adjunct therapy for patients with depression whose symptoms have not remitted through antidepressant treatment. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Journal of Counseling Psychology 04/2015; 62(2):115-123. DOI:10.1037/cou0000059 · 3.23 Impact Factor
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