BACKGROUND: Primary health care provides treatment for most patients with depression. Despite their importance for organizing services, long-term course of depression and risk factors for poor outcome in primary care are not well known. METHOD: In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients representing primary care patients in a Finnish city was screened for depression with the Primary Care Evaluation of Mental Disorders. SCID-I/P and SCID-II interviews were used to diagnose Axis I and II disorders. The 137 patients with DSM-IV depressive disorder were prospectively followed up at 3, 6, 18 and 60 months. Altogether, 82% of patients completed the 5-year follow-up, including 102 patients with a research diagnosis of major depressive disorder (MDD) at baseline. Duration of the index episode, recurrences, time spent in major depressive episodes (MDEs) and partial or full remission were examined with a life-chart. RESULTS: Of the MDD patients, 70% reached full remission, in a median time of 20 months. One-third had at least one recurrence. The patients spent 34% of the follow-up time in MDEs, 24% in partial remission and 42% in full remission. Baseline severity of depression and substance use co-morbidity predicted time spent in MDEs. CONCLUSIONS: This prospective, naturalistic, long-term study of a representative cohort of primary care patients with depression indicated slow or incomplete recovery and a commonly recurrent course, which need to be taken into account when developing primary care services. Severity of depressive symptoms and substance use co-morbidity should be systematically evaluated in planning treatment.
BACKGROUND: Primary health care provides treatment for most patients with depression. Despite their importance for organizing services, long-term course of depression and risk factors for poor outcome in primary care are not well known. METHOD: In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients representing primary care patients in a Finnish city was screened for depression with the Primary Care Evaluation of Mental Disorders. SCID-I/P and SCID-II interviews were used to diagnose Axis I and II disorders. The 137 patients with DSM-IV depressive disorder were prospectively followed up at 3, 6, 18 and 60 months. Altogether, 82% of patients completed the 5-year follow-up, including 102 patients with a research diagnosis of major depressive disorder (MDD) at baseline. Duration of the index episode, recurrences, time spent in major depressive episodes (MDEs) and partial or full remission were examined with a life-chart. RESULTS: Of the MDDpatients, 70% reached full remission, in a median time of 20 months. One-third had at least one recurrence. The patients spent 34% of the follow-up time in MDEs, 24% in partial remission and 42% in full remission. Baseline severity of depression and substance use co-morbidity predicted time spent in MDEs. CONCLUSIONS: This prospective, naturalistic, long-term study of a representative cohort of primary care patients with depression indicated slow or incomplete recovery and a commonly recurrent course, which need to be taken into account when developing primary care services. Severity of depressive symptoms and substance use co-morbidity should be systematically evaluated in planning treatment.
Authors: Claudi Bockting; Amanda M Legemaat; Johanne G J van der Stappen; Gert J Geurtsen; Maria Semkovska; Huibert Burger; Isidoor O Bergfeld; Nicoline Lous; Damiaan A J P Denys; Marlies Brouwer Journal: BMJ Open Date: 2022-06-23 Impact factor: 3.006
Authors: Carlos I Pérez Benítez; Nicholas J Sibrava; Laura Kohn-Wood; Andri S Bjornsson; Caron Zlotnick; Risa Weisberg; Martin B Keller Journal: Psychiatry Res Date: 2014-07-19 Impact factor: 3.222
Authors: James E Aikens; Marcia Valenstein; Melissa A Plegue; Ananda Sen; Nicolle Marinec; Eric Achtyes; John D Piette Journal: Telemed J E Health Date: 2021-06-04 Impact factor: 3.536
Authors: Christian Knöchel; Gilberto Alves; Benedikt Friedrichs; Barbara Schneider; Anna Schmidt-Rechau; Sofia Wenzler; Angelina Schneider; David Prvulovic; André F Carvalho; Viola Oertel-Knöchel Journal: Curr Neuropharmacol Date: 2015 Impact factor: 7.363
Authors: Judith Verduijn; Josine E Verhoeven; Yuri Milaneschi; Robert A Schoevers; Albert M van Hemert; Aartjan T F Beekman; Brenda W J H Penninx Journal: BMC Med Date: 2017-12-12 Impact factor: 8.775