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ABSTRACT: PURPOSE: Major depressive disorder may vary according to number and duration of episodes. It is unclear whether risk factors for onset of multiple or long episodes of depression (MDE) differ from risk factors for the onset of single and short ones. METHODS: Data were used from a cohort study of 5,256 GP attendees without major depressive disorder at baseline, who were followed up three times (predictD). The numbers and duration of MDE were noted and categorized into no episodes, single and short (≤3 months), and multiple or long (>3 months) episodes at follow-up. Log-binomial regression models were used to calculate relative risks between the groups for 18 risk factors examined at baseline. RESULTS: 165 persons (3 %) had a single and short MDE and 328 (6 %) had multiple or long MDE at follow-up. Lower education, anxiety, problems at work and financial strain significantly increased the risk of multiple or long MDE when compared to single and short MDE. Younger people were at reduced risk of multiple or long MDE. CONCLUSIONS: Our findings suggest that several risk factors can be identified that may help to predict onset of different types of MDE. These factors are easy to assess and may be used in the prevention of depression.
Social Psychiatry 11/2012; · 2.05 Impact Factor
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Bauke T Stegenga,
Michael King,
Diederick E Grobbee,
Francisco Torres-González,
Igor Švab,
Heidi-Ingrid Maaroos,
Miguel Xavier,
Sandra Saldivia,
Christian Bottomley,
Irwin Nazareth,
Mirjam I Geerlings
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ABSTRACT: Our aim is to examine which risk factors have a greater impact in women than in men on the risk of major depressive disorder (MDD) and whether factors differ between a possible recurrent MDD and a first onset of MDD.
Prospective cohort study of general practice attendees in seven countries, who were followed up at 6 and 12 months (predictD). Absolute risk differences (interaction contrast) across sex for onset of DSM-IV MDD after 6 or 12 months of follow-up were estimated for 35 risk factors from 7101 participants without MDD at baseline.
A total of 599 participants (80% female) had an onset of MDD at 6 or 12 months. Most risk factors had a greater impact in women than in men on the risk of MDD and were not restricted to a specific class of risk factors. After we stratified for a history of depressive symptoms, we found that the impact of risk factors across sex was generally stronger on possible recurrent MDD than on a first onset of MDD.
Our findings may partly account for the observed difference in incidence of MDD between men and women.
Annals of epidemiology 06/2012; 22(6):388-96. · 2.95 Impact Factor
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Bauke T Stegenga,
Irwin Nazareth,
Diederick E Grobbee,
Francisco Torres-González,
Igor Svab,
Heidi-Ingrid Maaroos,
Miguel Xavier,
Sandra Saldivia,
Christian Bottomley,
Michael King,
Mirjam I Geerlings
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ABSTRACT: The authors examined an additive model for the association of life events and age with onset of major depressive disorder (MDD) and whether the combination of life events and age posed greater risk than the sum of their independent effects.
Data were used from a prospective cohort study of 10,045 general practice attendees (PredictD). We included those without MDD at baseline (N=8293). We examined age divided into tertiles and into 10 year groups. Life events were assessed at baseline using the List of Threatening Life Experiences Questionnaire and categorized according to type. Main outcome measure was onset of DSM-IV MDD at 6 or 12 months of follow-up. The authors calculated Relative Excess Risks due to Interaction (RERI).
6910 persons (83.3%) had a complete follow-up, of whom 589 (8.5%) had an onset of MDD (166 younger, 254 middle aged and 169 older). The combined effect of personal problems (RERI=1.30; 95% CI 0.29 to 2.32), events in family or friends (RERI=1.23; 95% CI 0.28 to 2.19), or problems with law (RERI=1.57; 95% CI 0.33 to 2.82) and middle age was larger than the sum of individual effects.
Lower response to recruitment in the UK and the Netherlands.
Recent life events carry the largest risk of onset of MDD in mid-life. Understanding the different vulnerability to life events according to age may help to indicate groups at a particular risk and assist in preventive strategies.
Journal of affective disorders 11/2011; 136(3):505-13. · 3.76 Impact Factor
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ABSTRACT: Detection rates of depression in primary care are <50%. Studies showed similar outcome after 12 months for recognized and unrecognized depression. Outcome beyond 12 months is less well studied.
We investigated recognition of depression in primary care and its relation to outcome after 6, 12 and 39 months.
Data were used from a prospective cohort study of 1293 consecutive general practice attendees (PREDICT-NL), who were followed up after 6 (n = 1236), 12 (n = 1179) and 39 (n = 752) months. We measured the presence and severity of major depressive disorder (MDD) according to DSM-IV criteria and Patient Health Questionnaire 9 (PHQ-9) and mental function with Short Form 12 (SF-12). Recognition of depression was assessed using international classification of primary care codes (P03 and P76) and Anatomical Therapeutic Chemical (N06A) codes from the GP records (6 months before/after baseline).
At baseline, 170 (13%) of the participants had MDD, of whom 36% were recognized by their GP. The relative risk of being depressed after 39 months was 1.35 [95% confidence interval (CI) 0.7-2.7] for participants with recognized depression compared to unrecognized depression. At baseline, participants with recognized depression had more depressive symptoms (mean difference PHQ-9 2.7, 95% CI 1.6-3.9) and worse mental function (mean difference mental component summary -3.8, 95% CI -7.8 to 0.2) than unrecognized depressed participants. After 12 and 39 months, mean scores for both groups did not differ but were worse than those without depression.
A minority of patients with MDD is recognized in primary care. Those who were unrecognized had comparable outcome after 12 and 39 months as participants with recognized depression.
Family Practice 08/2011; 29(1):16-23. · 1.50 Impact Factor
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ABSTRACT: Depression, anxiety and physical function may be bi-directionally related. We aim to estimate the strength of the longitudinal associations between depression, anxiety and physical function.
Prospective cohort study of general practice attendees across Europe (N=4757) assessed at baseline, 6, 12 and 24 months. Main outcome measures were Diagnostic and Statistical Manual of Mental Disorders-IV major depression, Patient Health Questionnaire anxiety and Short Form 12 physical function. Complete-case analyses using random coefficient models and logistic regression models were performed.
Those with depression (β=-1.90, 95% CI -3.42 to -0.39), anxiety (β=-4.12, 95% CI -5.39 to -2.86) or depression and anxiety (β=-5.74, 95% CI -7.38 to -4.10) had lower levels of physical function at baseline and over time compared with no diagnosis after adjustment for potential confounders. Physical function increased over time, but the rate of increase was not different between the groups. When compared with depression, those with anxiety (β=-2.22, 95% CI -4.08 to -0.36) or depression and anxiety (β=-3.83, 95% CI -5.95 to -1.71) had significantly lower levels of physical function at baseline. Lower levels of physical function at baseline were associated with onset of depression (OR 1.83, 95% CI 1.08 to 3.10) but even stronger with anxiety (OR 2.79, 95% CI 1.52 to 5.12) or depression and anxiety (OR 5.05, 95% CI 2.55 to 9.99) during 24 months compared with no dysfunction, after adjustment for potential confounders.
It is essential to prevent lower levels of physical function as this is likely to lead to onset of depression and anxiety over time.
Journal of epidemiology and community health 06/2011; 66(7):e25. · 3.04 Impact Factor
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ABSTRACT: To examine the natural course and outcome of major depressive disorder (MDD) in primary care over 39 months.
Prospective 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.
At 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.
Although 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.
Social Psychiatry 11/2010; 47(1):87-95. · 2.05 Impact Factor
