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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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