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Five-year outcome of major depressive disorder in primary health care

Published online by Cambridge University Press:  16 November 2011

K. A. Riihimäki ,
M. S. Vuorilehto ,
T. K. Melartin  and
E. T. Isometsä
K. A. Riihimäki
Affiliation:
National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland Primary Health Care Organization of the City of Vantaa, Vantaa, Finland
M. S. Vuorilehto
Affiliation:
National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland Ministry of Social Affairs and Health, Helsinki, Finland
T. K. Melartin
Affiliation:
National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland Department of Psychiatry, HUCH, Jorvi Hospital, Espoo, Finland
E. T. Isometsä*
Affiliation:
National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland Department of Psychiatry, University of Helsinki, Helsinki, Finland
*
*Address for correspondence: Professor E. T. Isometsä, MD, PhD, Department of Psychiatry, Institute of Clinical Medicine, P.O. Box 22, 00014University of Helsinki, Finland. (Email: [email protected])
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Abstract

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.

Keywords

Co-morbiditycoursedepressionfollow-upoutcomeprimary carerecoveryrecurrence
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 7 , May 2014 , pp. 1369 - 1379
Copyright
Copyright © Cambridge University Press 2011 

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References

Alnaes, R, Torgersen, S (1997). Personality and personality disorders predict development and relapses of major depression. Acta Psychiatrica Scandinavica 95, 336–342.Google Scholar
Angst, J, Preisig, M (1995). Course of a clinical cohort of unipolar, bipolar and schizoaffective patients. Results of a prospective study from 1959 to 1985. Schweizer Archiv fur Neurologie und Psychiatrie 146, 5–16.Google ScholarPubMed
Beck, A, Ward, C, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.Google Scholar
Beck, AT, Epstein, N, Brown, G, Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893–897.Google Scholar
Beck, AT, Kovacs, M, Weissman, A (1979). Assessment of suicidal intention: the Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology 47, 343–352.Google Scholar
Beck, AT, Weissman, A, Lester, D, Trexler, L (1974). The measurement of pessimism: the hopelessness scale. Journal of Consulting and Clinical Psychology 42, 861–865.Google Scholar
Blumenthal, JA, Burg, MM, Barefoot, J, Williams, RB, Haney, T, Zimet, G (1987). Social support, type A behavior, and coronary artery disease. Psychosomatic Medicine 49, 331–340.CrossRefGoogle ScholarPubMed
Casey, P, Birbeck, G, McDonagh, C, Horgan, A, Dowrick, C, Dalgard, O, Lethinen, V, Ayuso-Mateos, JL, Dunn, G, Page, H, Wilkinson, C, Wilkinson, G, Vazquez-Barquero, JL (2004). Personality disorder, depression and functioning: results from the ODIN study. Journal of Affective Disorders 82, 277–283.CrossRefGoogle ScholarPubMed
Coryell, W, Endicott, J, Keller, M (1992). Major depression in a nonclinical sample. Demographic and clinical risk factors for first onset. Archives of General Psychiatry 49, 117–125.Google Scholar
Eaton, WW, Shao, H, Nestadt, G, Lee, HB, Bienvenu, OJ, Zandi, P (2008). Population-based study of first onset and chronicity in major depressive disorder. Archives of General Psychiatry 65, 513–520.Google Scholar
Farabaugh, A, Fava, M, Mischoulon, D, Sklarsky, K, Petersen, T, Alpert, J (2005). Relationships between major depressive disorder and comorbid anxiety and personality disorders. Comprehensive Psychiatry 46, 266–271.Google Scholar
First, M, Spitzer, R, Gibbon, M (1997). Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). American Psychiatric Press, Inc.: Washington, DC.Google Scholar
First, M, Spitzer, R, Gibbon, M (2001). Structural Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition with Psychotic Screen. New York State Psychiatric Institute: New York.Google Scholar
Furukawa, TA, Fujita, A, Harai, H, Yoshimura, R, Kitamura, T, Takahashi, K (2008). Definitions of recovery and outcomes of major depression: results from a 10-year follow-up. Acta Psychiatrica Scandinavica 117, 35–40.Google Scholar
Goldberg, DP, Jenkins, L, Millar, T, Faragher, EB (1993). The ability of trainee general practitioners to identify psychological distress among their patients. Psychological Medicine 23, 185–193.CrossRefGoogle ScholarPubMed
Goldman, HH, Skodol, AE, Lave, TR (1992). Revising axis V for DSM-IV: a review of measures of social functioning. American Journal of Psychiatry 149, 1148–1156.Google ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.Google Scholar
Hasin, DS, Tsai, WY, Endicott, J, Mueller, TI, Coryell, W, Keller, M (1996). Five-year course of major depression: effects of comorbid alcoholism. Journal of Affective Disorders 41, 63–70.Google Scholar
Holma, KM, Holma, IA, Melartin, TK, Rytsälä, HJ, Isometsä, ET (2008). Long-term outcome of major depressive disorder in psychiatric patients is variable. Journal of Clinical Psychiatry 69, 196–205.CrossRefGoogle ScholarPubMed
Hämäläinen, J, Isometsä, E, Laukkala, T, Kaprio, J, Poikolainen, K, Heikkinen, M, Lindeman, S, Aro, H (2004). Use of health services for major depressive episode in Finland. Journal of Affective Disorders 79, 105–112.Google Scholar
Hämäläinen, J, Isometsä, E, Sihvo, S, Kiviruusu, O, Pirkola, S, Lönnqvist, J (2009). Treatment of major depressive disorder in the Finnish general population. Depression and Anxiety 26, 1049–1059.Google Scholar
Hämäläinen, J, Isometsä, E, Sihvo, S, Pirkola, S, Kiviruusu, O (2008). Use of health services for major depressive and anxiety disorders in Finland. Depression and Anxiety 25, 27–37.Google Scholar
Jackson, JL, Passamonti, M, Kroenke, K (2007). Outcome and impact of mental disorders in primary care at 5 years. Psychosomatic Medicine 69, 270–276.CrossRefGoogle ScholarPubMed
Johnson, JG, Cohen, P, Kasen, S, Brook, JS (2005). Personality disorder traits associated with risk for unipolar depression during middle adulthood. Psychiatry Research 136, 113–121.Google Scholar
Keeley, RD, Smith, JL, Nutting, PA, Miriam Dickinson, L, Perry Dickinson, W, Rost, KM (2004). Does a depression intervention result in improved outcomes for patients presenting with physical symptoms? Journal of General Internal Medicine 19, 615–623.CrossRefGoogle ScholarPubMed
Keller, MB (1992). The naturalistic course of anxiety and depressive disorders. Clinical Neuropharmacology 15 (Suppl. 1 Pt A), 171A–173A.Google Scholar
Keller, MB, Klerman, GL, Lavori, PW, Coryell, W, Endicott, J, Taylor, J (1984). Long-term outcome of episodes of major depression. Clinical and public health significance. Journal of the American Medical Association 252, 788–792.Google Scholar
Keller, MB, Lavori, PW, Mueller, TI, Endicott, J, Coryell, W, Hirschfeld, RM, Shea, T (1992). Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Archives of General Psychiatry 49, 809–816.Google Scholar
Kennedy, N, Abbott, R, Paykel, ES (2003). Remission and recurrence of depression in the maintenance era: long-term outcome in a Cambridge cohort. Psychological Medicine 33, 827–838.Google Scholar
Kennedy, N, Abbott, R, Paykel, ES (2004). Longitudinal syndromal and sub-syndromal symptoms after severe depression: 10-year follow-up study. British Journal of Psychiatry 184, 330–336.Google Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, Rush, AJ, Walters, EE, Wang, PS (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association 289, 3095–3105.Google Scholar
Kiloh, LG, Andrews, G, Neilson, M (1988). The long-term outcome of depressive illness. British Journal of Psychiatry 153, 752–757.Google Scholar
Lee, AS, Murray, RM (1988). The long-term outcome of Maudsley depressives. British Journal of Psychiatry 153, 741–751.Google Scholar
Mattisson, C, Bogren, M, Horstmann, V, Tambs, K, Munk-Jorgensen, P, Nettelbladt, P (2009). Risk factors for depressive disorders in the Lundby cohort – a 50 year prospective clinical follow-up. Journal of Affective Disorders 113, 203–215.Google Scholar
Melartin, TK, Rytsälä, HJ, Leskelä, US, Lestelä-Mielonen, PS, Sokero, TP, Isometsä, ET (2004). Severity and comorbidity predict episode duration and recurrence of DSM-IV major depressive disorder. Journal of Clinical Psychiatry 65, 810–819.Google Scholar
Mueller, TI, Lavori, PW, Keller, MB, Swartz, A, Warshaw, M, Hasin, D, Coryell, W, Endicott, J, Rice, J, Akiskal, H (1994). Prognostic effect of the variable course of alcoholism on the 10-year course of depression. American Journal of Psychiatry 151, 701–706.Google Scholar
Muthén, LK, Muthén, BO (2007). Mplus User's Guide. Muthén & Muthén: Los Angeles.Google Scholar
NICE (2010). The Treatment and Management of Depression in Adults with Chronic Physical Health Problems. (NICE Clinical Guideline 91). National Institute for Health and Clinical Excellence: London.Google Scholar
Oldehinkel, AJ, Ormel, J, Neeleman, J (2000). Predictors of time to remission from depression in primary care patients: do some people benefit more from positive life change than others? Journal of Abnormal Psychology 109, 299–307.Google Scholar
Ormel, J, Oldehinkel, T, Brilman, E, vanden Brink, W (1993). Outcome of depression and anxiety in primary care. A three-wave 3 1/2-year study of psychopathology and disability. Archives of General Psychiatry 50, 759–766.CrossRefGoogle ScholarPubMed
Paykel, ES, Ramana, R, Cooper, Z, Hayhurst, H, Kerr, J, Barocka, A (1995). Residual symptoms after partial remission: an important outcome in depression. Psychological Medicine 25, 1171–1180.Google Scholar
Pirkola, SP, Isometsä, E, Suvisaari, J, Aro, H, Joukamaa, M, Poikolainen, K, Koskinen, S, Aromaa, A, Lönnqvist, JK (2005). DSM-IV mood-, anxiety- and alcohol use disorders and their comorbidity in the Finnish general population – results from the Health 2000 Study. Social Psychiatry and Psychiatric Epidemiology 40, 1–10.CrossRefGoogle ScholarPubMed
Poutanen, O, Mattila, A, Seppälä, NH, Groth, L, Koivisto, AM, Salokangas, RK (2007). Seven-year outcome of depression in primary and psychiatric outpatient care: results of the TADEP (Tampere Depression) II Study. Nordic Journal of Psychiatry 61, 62–70.Google Scholar
Rhebergen, D, Beekman, AT, Graaf, R, Nolen, WA, Spijker, J, Hoogendijk, WJ, Penninx, BW (2009). The three-year naturalistic course of major depressive disorder, dysthymic disorder and double depression. Journal of Affective Disorders 115, 450–459.Google Scholar
Rost, K (2009). Disability from depression: the public health challenge to primary care. Nordic Journal of Psychiatry 63, 17–21.Google Scholar
Sartorius, N, Ustun, TB, Costae Silva, JA, Goldberg, D, Lecrubier, Y, Ormel, J, von Korff, M, Wittchen, HU (1993). An international study of psychological problems in primary care. Preliminary report from the World Health Organization Collaborative Project on ‘Psychological Problems in General Health Care’. Archives of General Psychiatry 50, 819–824.Google Scholar
Simon, GE (2000). Long-term prognosis of depression in primary care. Bulletin of the World Health Organization 78, 439–445.Google Scholar
Solomon, DA, Leon, AC, Coryell, W, Mueller, TI, Posternak, M, Endicott, J, Keller, MB (2008). Predicting recovery from episodes of major depression. Journal of Affective Disorders 107, 285–291.Google Scholar
Spijker, J, de Graaf, R, Bijl, RV, Beekman, AT, Ormel, J, Nolen, WA (2002). Duration of major depressive episodes in the general population: results from The Netherlands Mental Health Survey and Incidence Study (NEMESIS). British Journal of Psychiatry 181, 208–213.Google Scholar
Spitzer, RL, Williams, JB, Kroenke, K, Linzer, M, deGruy, FV 3rd, Hahn, SR, Brody, D, Johnson, JG (1994). Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. Journal of the American Medical Association 272, 1749–1756.Google Scholar
Stegenga, BT, Kamphuis, MH, King, M, Nazareth, I, Geerlings, MI (2010). The natural course and outcome of major depressive disorder in primary care: the PREDICT-NL study. Social Psychiatry and Psychiatric Epidemiology, doi: 10.1007/s00127-010-0317-9, Published online 6 11 2010 .Google Scholar
van Weel-Baumgarten, E, van den Bosch, W, van den Hoogen, H, Zitman, FG (1998). Ten year follow-up of depression after diagnosis in general practice. British Journal of General Practice 48, 1643–1646.Google Scholar
Wells, KB, Tang, L, Miranda, J, Benjamin, B, Duan, N, Sherbourne, CD (2008). The effects of quality improvement for depression in primary care at nine years: results from a randomized, controlled group-level trial. Health Services Research 43, 1952–1974.Google Scholar
Widmer, RB, Cadoret, RJ (1978). Depression in primary care: changes in pattern of patient visits and complaints during a developing depression. Journal of Family Practice 7, 293–302.Google Scholar
Viinamäki, H, Hintikka, J, Honkalampi, K, Koivumaa-Honkanen, H, Kuisma, S, Antikainen, R, Tanskanen, A, Lehtonen, J (2002). Cluster C personality disorder impedes alleviation of symptoms in major depression. Journal of Affective Disorders 71, 35–41.Google Scholar
Wilson, I, Duszynski, K, Mant, A (2003). A 5-year follow-up of general practice patients experiencing depression. Family Practice 20, 685–689.Google Scholar
Vuorilehto, M, Melartin, T, Isometsä, E (2005). Depressive disorders in primary care: recurrent, chronic, and co-morbid. Psychological Medicine 35, 673–682.Google Scholar
Vuorilehto, MS, Melartin, TK, Isometsa, ET (2009). Course and outcome of depressive disorders in primary care: a prospective 18-month study. Psychological Medicine 39, 1697–1707.Google Scholar
Yiend, J, Paykel, E, Merritt, R, Lester, K, Doll, H, Burns, T (2009). Long term outcome of primary care depression. Journal of Affective Disorders 118, 79–86.CrossRefGoogle ScholarPubMed
Zimmerman, M, Coryell, W (1989). DSM-III personality disorder diagnoses in a nonpatient sample. Demographic correlates and comorbidity. Archives of General Psychiatry 46, 682–689.Google Scholar