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Clinical and Psychosocial Origins of Chronic Depressive Episodes

II: A Patient Enquiry

Published online by Cambridge University Press:  02 January 2018

George W. Brown ,
P. Moran ,
T. O. Harris ,
C. Hepworth  and
R. Robinson
George W. Brown*
Affiliation:
Royal Holloway College, London
P. Moran
Affiliation:
Royal Holloway College, London
T. O. Harris
Affiliation:
Royal Holloway College, London
C. Hepworth
Affiliation:
University of North London
R. Robinson
Affiliation:
Royal Holloway College, London
*
Professor George Brown, Department of Social Policy and Social Science, Royal Holloway College, University of London, 11 Bedford Square, London WC1B 3RA
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Abstract

Background

We consider how well the psychosocial and clinical factors found to predict a chronic course for depressive episodes in the community, held for female psychiatric patients.

Method

A consecutive series of depressed patients, aged 18 to 60, treated as in-patients, out-patients or day-patients at psychiatric departments of two London hospitals, were interviewed initially and at follow-up two years later.

Results

Indices of childhood adversity and current interpersonal difficulties predicted episodes taking a chronic course (of more than 12 months' duration). Half of the episodes associated with one or the other factor were chronic, compared with 22% of those with neither. The patients were at higher risk than the community series (75% v. 34%) and this explains their much greater rate of chronicity. There was also some evidence that social support reduced risk. Clinical features and the presence of a personality disorder were unrelated to chronicity.

Conclusions

Similar psychosocial factors are important for predicting chronicity in both community and patient series.

Type
Papers
Information
The British Journal of Psychiatry , Volume 165 , Issue 4 , October 1994 , pp. 457 - 465
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Andrews, B. & Brown, G. W. (1988a) Marital violence in the community. A biographical approach. British Journal of Psychiatry, 153, 305–312.Google Scholar
Andrews, B. & Brown, G. W. (1988b) Social support, onset of depression and personality: an exploratory analysis. Social Psychiatry, 23, 99–108.Google Scholar
Andrews, B., Neilson, M., Hunt, C., et al (1990) Diagnosis, personality and the long-term outcome of depression. British Journal of Psychiatry, 157, 13–18.Google Scholar
Akiskal, H. S. (1982) Factors associated with incomplete recovery in primary depressive illness. Journal of Clinical Psychiatry, 43, 266–271.Google Scholar
Angst, J. (1988) Clinical course of affective disorders. In Depressive Illness: Prediction of Course and Outcome (eds Helgason, T. & Daly, R. J.). Berlin: Springer-Verlag.Google Scholar
Asarnow, J. R., Goldstein, M. J., Thompson, M., et al (1993) One-year outcomes of depressive disorders in child psychiatric in-patients: evaluation of the prognostic power of a brief measure of expressed emotion. Journal of Child Psychology and Psychiatry, 34, 129–137.Google Scholar
Bebbington, P. E., Tennant, C. & Hurry, J. (1981) Adversity and the nature of psychiatric disorder in the community. Journal of Affective Disorders, 3, 345–366.Google Scholar
Bifulco, A., Brown, G. W. & Harris, T. O. (1987) Childhood loss of parent, lack of adequate parental care and adult depression: a replication. Journal of Affective Disorders, 12, 115–128.Google Scholar
Bifulco, A., Brown, G. W. & Adler, Z. (1991) Early sexual abuse and clinical depression in adult life. British Journal of Psychiatry, 159, 115–122.Google Scholar
Bifulco, A., Brown, G. W. & Harris, T. O. (1994) Childhood Experience of Care and Abuse (CECA): a retrospective interview measure. Child Psychology and Psychiatry (in press).Google Scholar
Brown, G. W. (1988) Causal paths, chains and strands. In Studies of Psychological Risk: the Power of Longitudinal Data (ed. Rutter, M.). Cambridge: Cambridge University Press.Google Scholar
Brown, G. W. (1989) Life events and measurement. In Life Events and Illness (eds Brown, G. W. & Harris, T.). New York: Guilford Press.Google Scholar
Brown, G. W. (1992) Social support: an investigator-based approach. In The Meaning and Measurement of Social Support (eds Veiel, H. O. F. & Baumann, U.), pp. 235–257. Washington: Hemisphere.Google Scholar
Brown, G. W. (1993) Life events and affective disorder: replications and limitations. Psychosomatic Medicine, 55, 248–259.Google Scholar
Brown, G. W. & Harris, T. O. (1978) Social Origins of Depression: A Study of Psychiatric Disorder in Women. London: Tavistock.Google Scholar
Brown, G. W. & Prudo, R. (1981) Psychiatric disorder in a rural and an urban population: 1. Aetiology and depression. Psychological Medicine, 11, 581–599.Google Scholar
Brown, G. W., Craig, T. K. J. & Harris, T. O. (1985) Depression: disease or distress? Some epidemiological considerations. British Journal of Psychiatry, 147, 612–622.Google Scholar
Brown, G. W. & Harris, T. O. (1986a) Establishing causal links: the Bedford College Studies of Depression. In Life Events and Psychiatric Disorders (ed. Katschnig, H.). Cambridge: Cambridge University Press.Google Scholar
Brown, G. W. & Harris, T. O. (1986b) Stressor, vulnerability and depression: a question of replication. Psychological Medicine, 16, 739–744.Google Scholar
Brown, G. W., Andrews, B., Harris, T. O., et al (1986a) Social support, self-esteem and depression. Psychological Medicine, 16, 813–831.Google Scholar
Brown, G. W., Bifulco, A., Harris, T., et al (1986b) Life stress, subclinical symptoms and vulnerability to clinical depression. Journal of Affective Disorders, 11, 1–19.Google Scholar
Brown, G. W., Adler, A. & Bifulco, A. (1988) Life events, difficulties and recovery from chronic depression. British Journal of Psychiatry, 152, 487–498.Google Scholar
Brown, G. W., & Harris, T. O. (1989) Depression. In Life Events and Illness (eds Brown, G. W. & Harris, T. O.). New York: Guilford Press.Google Scholar
Brown, G. W., Bifulco, A. & Andrews, B. (1990) Self-esteem and depression: 3. Aetiological issues. Social Psychiatry and Psychiatric Epidemiology, 25, 235–243.Google Scholar
Brown, G. W., Lemyre, L. & Bifulco, A. (1992) Social factors and recovery from anxiety and depressive disorders: a test of the specificity. British Journal of Psychiatry, 161, 44–54.Google Scholar
Brown, G. W., & Harris, T. O. (1993) Aetiology of anxiety and depressive disorders in an inner-city population. 1. Early adversity. Psychological Medicine, 23, 143–154.Google Scholar
Brown, G. W., Harris, T. O. & Hepworth, C. (1994) Life events and ‘endogenous’ depression: a puzzle re-examined. Archives of General Psychiatry, 51, 525–534.Google Scholar
Carney, M. W. P., Reynolds, E. H. & Sheffield, B. F. (1987) Prediction of outcome in depressive illness by the Newcastle Diagnosis Scale: its relationship with the unipolar/bipolar and DSM-III systems. British Journal of Psychiatry, 150, 43–48.Google Scholar
Cooper, J. E., Copeland, J. R. N., Brown, G. W., et al (1977) Further studies on interview training and inter-rater reliability of the Present State Examination (PSE). Psychological Medicine, 7, 517–523.Google Scholar
Coryell, W., Endicott, J. & Keller, M. (1987) The importance of psychotic features to major depression: course and outcome during a 2-year follow-up. Acta Psychiatrica Scandinavica, 75, 78–85.Google Scholar
Coyne, J. C. & Downey, G. (1991) Social factors and psychopathology: stress, social support and the coping processes. Annual Review of Psychology, 42, 401–425.Google Scholar
Dean, C., Surtees, P. G. & Sashidharan, S. P. (1983) Comparison of research diagnostic systems in an Edinburgh community sample. British Journal of Psychiatry, 142, 247–256.Google Scholar
Eccleston, D. & Scott, J. (1991) Treatment, prediction of relapse and prognosis of chronic primary major depression. International Clinical Psychopharmacology, 6 (suppl. 2), 3–10.Google Scholar
Finlay-Jones, R., Brown, G. W., Duncan-Jones, P., et al (1980) Depression and anxiety in the community: replicating and diagnosis of a case. Psychological Medicine, 10, 445–454.Google Scholar
Finlay-Jones, R., Brown, G. W., Duncan-Jones, P., (1981) Types of stressful life event and the onset of anxiety and depressive disorders. Psychological Medicine, 11, 803–815.Google Scholar
Gaminde, I., Uria, M., Padro, D., et al (1993) Depression in three populations in the Basque country – a comparison with Britain. Social Psychiatry and Psychiatric Epidemiology, 28, 243–251.Google Scholar
George, L. K., Blazer, D. G., Hughes, D. C., et al (1989) Social support and the outcome of major depression. British Journal of Psychiatry, 154, 478–485.Google Scholar
Giel, R., Ten Horn, G. H. M. M., Ormel, J., et al (1978) Mental illness, neuroticism and life events in a Dutch village sample: a follow-up. Psychological Medicine, 8, 235–243.Google Scholar
Goering, P. N., Lancee, W. J. & Freeman, S. J. J. (1992) Marital support and recovery from depression. British Journal of Psychiatry, 160, 76–82.Google Scholar
Gonzales, L. R., Lewisohn, P. M. & Clarke, G. N. (1985) Longitudinal follow-up of unipolar depressives: an investigation of predictors of relapse. Journal of Consulting and Clinical Psychology, 53, 461–469.Google Scholar
Harrington, R. (1992) Annotation: the natural history and treatment of child and adolescent affective disorders. Journal of Child Psychology and Psychiatry, 33, 1287–1302.Google Scholar
Harris, T. O., Brown, G. W. & Bifulco, A. (1986) Loss of parent in childhood and adult psychiatric disorder: the Walthamstow Study. 1: The role of lack of adequate parental care. Psychological Medicine, 16, 641–659.Google Scholar
Harris, T. O., Brown, G. W., Craig, T. J. K., et al (1994) Past loss and symptom morphology in depression: the mediating role of childhood adversity and current personality. (In preparation.) Google Scholar
Hellevick, O. (1984) Introduction to Causal Analysis: Exploring Survey Data by Crosstabulation. London: George Allen & Unwin.Google Scholar
Hickie, I. & Parker, G. (1992) The impact of an uncaring partner on improvement in non-melancholic depression. Journal of Affective Disorders, 25, 147–160.Google Scholar
Huxley, P. J., Goldberg, D. P., Maguire, G. P., et al (1979) The prediction of the course of minor psychiatric disorders. British Journal of Psychiatry, 135, 535–543.Google Scholar
Keller, M. B., Shapiro, R. W., Lavori, P. W., et al (1982) Recovery in major depressive disorder: analysis with the life table and regression models. Archives of General Psychiatry, 39, 905–910.Google Scholar
Keller, M. B., Lavori, P. W., Endicott, J., et al (1983) “Double depression”: two-year follow-up. American Journal of Psychiatry, 140, 689–694.Google Scholar
Keller, M. B., Lavori, P. W., Rice, J., et al (1986) The persistent risk of chronicity in recurrent episodes of nonbipolar major depressive disorder: a prospective follow-up. American Journal of Psychiatry, 143, 24–28.Google Scholar
Keller, M. B., Lavori, P. W., Friedman, B., et al (1987) The longitudinal interval follow-up evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540–548.Google Scholar
Keller, M. B., Beardslee, W., Lavori, P. W., et al (1988) Course of major depression in nonreferred adolescents: a retrospective study. Journal of Affective Disorders, 15, 235–243.Google Scholar
Keller, M. B., Lavori, P. W., Mueller, T. I., et al (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
Kiloh, L. G., Andrews, G. & Neilson, M. (1988) The long-term outcome of depressive illness. British Journal of Psychiatry, 153, 752–757.Google Scholar
Klerman, G. L. & Weissman, M. M. (1992) The course, morbidity, and costs of depression. Archives of General Psychiatry, 49, 831–834.Google Scholar
Kovacs, M., Feinberg, T. L., Crouse-Novak, M. A., et al (1984) Depressive disorders in childhood. I. A longitudinal prospective study of characteristics and recovery. Archives of General Psychiatry, 41, 229–237.Google Scholar
Lee, A. S. & Murray, R. M. (1988) The long-term outcome of Maudsley depressives. British Journal of Psychiatry, 153, 741–751.Google Scholar
Lewinsohn, P. M., Fenn, D. S., Stanton, A. K., et al (1986) Relation of age at onset to duration of episode in unipolar depression. Journal of Psychology and Aging, 1, 63–68.Google Scholar
Mann, A. H., Jenkins, R. & Belsey, E. (1981) The twelve-month outcome of patients with neurotic illness in general practice. Psychological Medicine, 11, 535–550.Google Scholar
McLeod, J. D., Kessler, R. C. & Landis, K. R. (1992) Speed of recovery from major depressive episodes in a community sample of married men and women. Journal of Abnormal Psychology, 101, 277–286.Google Scholar
Murphy, E. (1983) The prognosis of depression in old age. British Journal of Psychiatry, 142, 111–119.Google Scholar
Neilson, E., Brown, G. W. & Marmot, M. (1989) Myocardial infarction. In Life Events and Illness (eds Brown, G. W. & Harris, T. O.), pp. 313–342. New York: Guilford Press.Google Scholar
Norusis MJ/SPSS Inc. (1990) SPSS/PC+ Advanced Statistics for the IBM PC/XT/AT and PS/2. Chicago: SPSS.Google Scholar
Post, F. (1972) The management and nature of depressive illness in late life: a follow-through study. British Journal of Psychiatry, 121, 393–404.Google Scholar
Prudo, R., Brown, G. W., Harris, T. O., et al (1981) Psychiatric disorder in a rural and an urban population: 2. Sensitivity to loss. Psychological Medicine, 11, 601–616.Google Scholar
Prudo, R., Brown, G. W., & Harris, T. O., (1984) Psychiatric disorder in a rural and an urban population: 3. Social integration and the morphology of affective disorder. Psychological Medicine, 14, 327–345.Google Scholar
Reich, J. H. (1989) Update on instruments to measure DSM-III and DSM-III-R personality disorders. Journal of Nervous and Mental Disease, 177, 366–370.Google Scholar
Roth, M. & Kay, D. W. K. (1956) Affective disorders arising in the senium. II. Physical disability as an aetiological factor. Journal of Mental Science, 102, 141–150.Google Scholar
Scott, J., Eccleston, D. & Boys, R. (1992) Can we predict the persistence of depression? British Journal of Psychiatry, 161, 633–637.Google Scholar
Sims, A. (1975) Factors predictive of outcome in neurosis. British Journal of Psychiatry, 127, 54–62.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1977) Research Diagnostic Criteria for a Selected Group of Functional Disorders (3rd edn). New York: Biometrics Research Division.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Schedule for Affective Disorders and Schizophrenia (SADS). New York: Biometrics Research Division.Google Scholar
Straus, M., Gelles, R. & Steinmetz, S. (1980) Behind Closed Doors: Violence in the American Family. New York: Anchor.Google Scholar
Surtees, P. G., Sashidharan, S. P. & Dean, C. (1986) Affective disorder amongst women in the general population: a longitudinal study. British Journal of Psychiatry, 148, 176–186.Google Scholar
Sylph, J. & Kedward, H. B. (1969) Chronic patients in general practice: a pilot study. Journal of the Royal College of General Practitioners, 17, 162–170.Google Scholar
Wells, K. B., Burnam, A., Rogers, W., et al (1992) The course of depression in adult outpatients: regults from the Medical Outcomes Study. Archives of General Psychiatry, 49, 788–794.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
Wing, J. K., Nixon, J. M., Mann, S. A., et al (1977) Reliability of the PSE (ninth edition) used in a population study. Psychological Medicine, 7, 505–516.Google Scholar
Wing, J. K., & Sturt, E. (1978) The PSE-ID-CATEGO System: Supplementary Manual. London: MRC Social Psychiatry Unit.Google Scholar
Wing, J. K., Babor, T., Brugha, T., et al (1990) SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry, 47, 589–593.Google Scholar
Wittchen, H-U. & Zerssen, D. von (1988) Verläufe behandelter und unbehandelter Depressionen und Angststörungen. Eine klinisch-psychiatrische und epidemiologische Verlaufsuntersuchung. Berlin: Springer.Google Scholar
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