Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-05T06:17:44.541Z Has data issue: false hasContentIssue false
  • English
  • Français

Estimating remission from untreated major depression: a systematic review and meta-analysis

Published online by Cambridge University Press:  10 August 2012

H. A. Whiteford ,
M. G. Harris ,
G. McKeon ,
A. Baxter ,
C. Pennell ,
J. J. Barendregt  and
J. Wang
H. A. Whiteford*
Affiliation:
Policy and Evaluation Group, Queensland Centre for Mental Health Research, QLD, Australia School of Population Health, The University of Queensland, QLD, Australia
M. G. Harris
Affiliation:
Policy and Evaluation Group, Queensland Centre for Mental Health Research, QLD, Australia School of Population Health, The University of Queensland, QLD, Australia
G. McKeon
Affiliation:
Policy and Evaluation Group, Queensland Centre for Mental Health Research, QLD, Australia
A. Baxter
Affiliation:
Policy and Evaluation Group, Queensland Centre for Mental Health Research, QLD, Australia School of Population Health, The University of Queensland, QLD, Australia
C. Pennell
Affiliation:
Policy and Evaluation Group, Queensland Centre for Mental Health Research, QLD, Australia
J. J. Barendregt
Affiliation:
School of Population Health, The University of Queensland, QLD, Australia
J. Wang
Affiliation:
Departments of Psychiatry and Community Health Sciences, University of Calgary, AB, Canada
*
*Address for correspondence: Professor H. A. Whiteford, The University of Queensland, School of Population Health, Queensland Centre for Mental Health Research, Locked Bag 500, Sumner Park BC, QLD 4074, Australia. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Few studies have examined spontaneous remission from major depression. This study investigated the proportion of prevalent cases of untreated major depression that will remit without treatment in a year, and whether remission rates vary by disorder severity.

Method

Wait-list controlled trials and observational cohort studies published up to 2010 with data describing remission from untreated depression at ⩽2-year follow-up were identified. Remission was defined as rescinded diagnoses or below threshold scores on standardized symptom measures. Nineteen studies were included in a regression model predicting the probability of 12-month remission from untreated depression, using logit transformed remission proportion as the dependent variable. Covariates included age, gender, study type and diagnostic measure.

Results

Wait-listed compared to primary-care samples, studies with longer follow-up duration and older adult compared to adult samples were associated with lower probability of remission. Child and adolescent samples were associated with higher probability of remission. Based on adult samples recruited from primary-care settings, the model estimated that 23% of prevalent cases of untreated depression will remit within 3 months, 32% within 6 months and 53% within 12 months.

Conclusions

It is undesirable to expect 100% treatment coverage for depression, given many will remit before access to services is feasible. Data were drawn from consenting wait-list and primary-care samples, which potentially over-represented mild-to-moderate cases of depression. Considering reported rates of spontaneous remission, a short untreated period seems defensible for this subpopulation, where judged appropriate by the clinician. Conclusions may not apply to individuals with more severe depression.

Keywords

Major depressive disordermeta-analysisnatural historyspontaneous remissionsystematic review
Type
Review Article
Information
Psychological Medicine , Volume 43 , Issue 8 , August 2013 , pp. 1569 - 1585
Copyright
Copyright © Cambridge University Press 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allen, JJ, Schnyer, RN, Hitt, SK (1998). The efficacy of acupuncture in the treatment of major depression in women. Psychological Science 9, 397–401.CrossRefGoogle Scholar
Allen, JJB, Schnyer, RN, Chambers, AS, Hitt, SK, Moreno, FA, Manber, R (2006). Acupuncture for depression: a randomized controlled trial. Journal of Clinical Psychiatry 67, 1665–1673.CrossRefGoogle ScholarPubMed
Alonso, J, Angermeyer, M, Bernert, S, Bruffaerts, R, Brugha, T, Bryson, H, de Girolamo, G, de Graaf, R, Demyttenaere, K, Gasquet, I, Haro, J, Katz, S, Kessler, R, Kovess, V, Lepine, J, Ormel, J, Polidori, G, Russo, L, Vilagurt, G (2004). Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica 109, 21–27.CrossRefGoogle Scholar
Andrews, G (2007). Tolkien II: A Needs-based, Costed, Stepped-care Model for Mental Health Services. World Health Organization, Collaborating Centre for Classification in Mental Health: Sydney.Google Scholar
Andrews, G, Issakidis, C, Carter, G (2001). Shortfall in mental health service utilisation. British Journal of Psychiatry 179, 417–425.CrossRefGoogle ScholarPubMed
Andrews, G, Simonella, L, Lapsley, H, Sanderson, K, March, L (2006). Evidence-based medicine is affordable: the cost-effectiveness of current compared with optimal treatment in rheumatoid and osteoarthritis. Journal of Rheumatology 33, 671–680.Google ScholarPubMed
Arean, PA, Perri, MG, Nezu, AM, Schein, RL, Christopher, F, Joseph, TX (1993). Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults. Journal of Consulting and Clinical Psychology 61, 1003–1010.CrossRefGoogle ScholarPubMed
Azorin, JM (1995). Spontaneous course of depression. Encephale 21, 31–34.Google ScholarPubMed
Beck, AT, Steer, RA (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review 8, 77–100.CrossRefGoogle Scholar
Buis, ML (2007). Predict and adjust with logistic regression. Stata Journal 7, 221–226.CrossRefGoogle Scholar
Burgess, PM, Pirkis, JE, Slade, TN, Johnston, AK, Meadows, GN, Gunn, JM (2009). Service use for mental health problems: findings from the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry 43, 615–623.CrossRefGoogle ScholarPubMed
Calabria, B, Degenhardt, L, Briegleb, C, Vos, T, Hall, W, Lynskey, M, Callaghan, B, Rana, U, McLaren, J (2010). Systematic review of prospective studies investigating ‘remission’ from amphetamine, cannabis, cocaine or opioid dependence. Addictive Behaviors 35, 741–749.CrossRefGoogle ScholarPubMed
Cisler, JM, Barnes, AC, Farnsworth, D, Sifers, SK (2007). Reporting practices of dropouts in psychological research using a wait-list control: current state and suggestions for improvement. International Journal of Methods in Psychiatric Research 16, 34–42.CrossRefGoogle ScholarPubMed
Clarke, GN, Rohde, P, Lewinsohn, PM, Hops, H, Seeley, JR (1999). Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions. Journal of the American Academy of Child and Adolescent Psychiatry 38, 272–279.CrossRefGoogle ScholarPubMed
Coryell, W, Endicott, J, Winokur, G, Akiskal, H, Solomon, D, Leon, A, Mueller, T, Shea, T (1995). Characteristics and significance of untreated major depressive disorder. American Journal of Psychiatry 152, 1124–1129.Google ScholarPubMed
Diamond, GS, Reis, BF, Diamond, GM, Siqueland, L, Isaacs, L (2002). Attachment-based family therapy for depressed adolescents: a treatment development study. Journal of the American Academy of Child and Adolescent Psychiatry 41, 1190–1196.CrossRefGoogle ScholarPubMed
Fox, HA (2002). The natural course of depression: Kraeplin and beyond. Harvard Review of Psychiatry 10, 249–253.CrossRefGoogle Scholar
Frank, E, Prien, RF, Jarrett, RB, Keller, MB, Kupfer, DJ, Lavori, PW, Rush, AJ, Weissman, MM (1991). Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence. Archives of General Psychiatry 48, 851–855.CrossRefGoogle ScholarPubMed
Goldberg, D, Privett, M, Ustun, B, Simon, G, Linden, M (1998). The effects of detection and treatment on the outcome of major depression in primary care: a naturalistic study in 15 cities. British Journal of General Practice 48, 1840–1844.Google ScholarPubMed
Griffiths, K, Farrer, L, Christensen, H (2010). The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials. Medical Journal of Australia 192, S4–S11.CrossRefGoogle ScholarPubMed
Grilo, CM, Sanislow, CA, Shea, MT, Skodol, AE, Stout, RL, Gunderson, JG, Yen, S (2005). Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity. Journal of Consulting and Clinical Psychology 73, 78–85.CrossRefGoogle ScholarPubMed
Hohman, LB (1938). A review of 144 cases of affective disorders after seven years. American Journal of Psychiatry 94, 304–308.Google Scholar
Israel, JA (2006). Remission in depression: definition and initial treatment approaches. Journal of Psychopharmacology 20, 5–10.CrossRefGoogle ScholarPubMed
Keller, MB (2003). Past, present, and future directions for defining optimal treatment outcome in depression: remission and beyond. Journal of the American Medical Association 289, 3152–3160.CrossRefGoogle ScholarPubMed
Kendler, KS, Walters, EE, Kessler, RC (1997). The prediction of length of major depressive episodes: results from an epidemiological sample of female twins. Psychological Medicine 27, 107–117.CrossRefGoogle ScholarPubMed
Kessler, R, Chiu, W, Demler, O, Walters, E (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kowalenko, N, Rapee, RM, Simmons, J, Wignall, A, Hoge, R, Whitefield, K, Starling, J, Stonehouse, R, Baillie, AJ (2005). Short-term effectiveness of a school-based early intervention program for adolescent depression. Clinical Child Psychology and Psychiatry 10, 493–507.CrossRefGoogle Scholar
Krøgsboll, LT, Hróbjartsson, A, Gøtzsche, PC (2009). Spontaneous improvement in randomised clinical trials: meta-analysis of three-armed trials comparing no treatment, placebo and active intervention. BMC Medical Research Methodology 9, 1.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Clarke, GN, Seeley, JR, Rohde, P (1994). Major depression in community adolescents: age at onset, episode duration, and time to recurrence. Journal of the American Academy of Child and Adolescent Psychiatry 33, 809–818.CrossRefGoogle ScholarPubMed
Licht-Strunk, E, Beekman, ATF, de Haan, M, van Marwijk, HWJ (2009). The prognosis of undetected depression in older general practice patients. A one year follow-up study. Journal of Affective Disorders 114, 310–315.CrossRefGoogle ScholarPubMed
Lim, D, Sanderson, K, Andrews, G (2000). Lost productivity among full-time workers with mental disorders. Journal of Mental Health Policy and Economics 3, 139–146.CrossRefGoogle ScholarPubMed
McGrath, J, Saha, S, Welham, J, El Saadi, O, MacCauley, C, Chant, D (2004). A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2, 13.CrossRefGoogle ScholarPubMed
McLeod, JD, Kessler, RC, Landis, KR (1992). Speed of recovery from major depressive episodes in a community sample of married men and women. Journal of Abnormal Psychology 101, 277–286.CrossRefGoogle Scholar
Meadows, G, Burgess, P (2009). Perceived need for mental health care: findings from the 2007 Australian Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry 43, 624–634.CrossRefGoogle ScholarPubMed
Mendlewicz, J (2009). Defining remission in depression: the challenge of complete recovery. Medicographia 31, 113–117.Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG; PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine 6, e1000097.CrossRefGoogle ScholarPubMed
Murray, CJ, Lopez, AD (1997). Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 349, 1436–1442.CrossRefGoogle ScholarPubMed
Musial, F, Klosterhalfen, S, Enck, P (2007). Placebo responses in patients with gastrointestinal disorders. World Journal of Gastroenterology 13, 3425–3429.CrossRefGoogle ScholarPubMed
NICE (2009). NICE Clinical Guideline 90. Depression: The Treatment and Management of Depression in Adults (partial update of NICE Clinical Guideline 23). The British Psychological Society and the Royal College of Psychiatrists: London, UK.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
Pace, TM, Dixon, DN (1993). Changes in depressive self-schemata and depressive symptoms following cognitive therapy. Journal of Counseling Psychology 40, 288–294.CrossRefGoogle Scholar
Posternak, MA, Miller, I (2001). Untreated short-term course of major depression: a meta-analysis of outcomes from studies using wait-list control groups. Journal of Affective Disorders 66, 139–146.CrossRefGoogle ScholarPubMed
Posternak, MA, Solomon, DA, Leon, AC, Mueller, TI, Shea, M, Endicott, J, Keller, MB (2006). The naturalistic course of unipolar major depression in the absence of somatic therapy. Journal of Nervous and Mental Disease 194, 324–329.CrossRefGoogle ScholarPubMed
Posternak, MA, Zimmerman, M (2000). Short-term spontaneous improvement rates in depressed outpatients. Journal of Nervous and Mental Disease 188, 799–804.CrossRefGoogle ScholarPubMed
Reynolds, WM, Coats, KI (1986). A comparison of cognitive-behavioral therapy and relaxation training for treatment of depression in adolescents. Journal of Consulting and Clinical Psychology 54, 653–660.CrossRefGoogle ScholarPubMed
Rost, K, Zhang, M, Fortney, J, Smith, J, Coyne, J, Smith, G (1998). Persistently poor outcomes of undetected major depression in primary care. General Hospital Psychiatry 20, 12–20.CrossRefGoogle ScholarPubMed
Sareen, J, Cox, B, Afifi, T, Clara, I, Yu, B (2005). Perceived need for mental health treatment in a nationally representative Canadian sample. Canadian Journal of Psychiatry 50, 643–651.CrossRefGoogle Scholar
Schorer, C (1970). Improvement with and without psychotherapy. Diseases of the Nervous System 31, 155–160.Google ScholarPubMed
Schorer, C, Lowinger, P, Sullivan, T, Hartlaub, GH (1968). Improvement without treatment. Diseases of the Nervous System 29, 100–104.Google ScholarPubMed
Schulberg, HC, Block, MR, Madonia, MJ, Scott, PC, Lave, JR, Rodriguez, E, Coulehan, JL (1997). The ‘usual care’ of major depression in primary care practice. Archives of Family Medicine 6, 334–339.CrossRefGoogle ScholarPubMed
Schulberg, HC, McClelland, M, Gooding, W (1987). Six-month outcomes for medical patients with major depressive disorders. Journal of General Internal Medicine 2, 312–317.CrossRefGoogle ScholarPubMed
Selmi, PM, Klein, MH, Greist, JH, Sorrell, SP, Erdman, HP (1990). Computer-administered cognitive-behavioral therapy for depression. American Journal of Psychiatry 147, 51–56.Google ScholarPubMed
Shaw, BF (1977). Comparison of cognitive therapy and behavior therapy in the treatment of depression. Journal of Consulting and Clinical Psychology 45, 543–551.CrossRefGoogle ScholarPubMed
Simon, GE, Fleck, M, Lucas, R, Bushnell, DM (2004). Prevalence and predictors of depression treatment in an international primary care study. American Journal of Psychiatry 161, 1626–1634.CrossRefGoogle Scholar
Simon, GE, Goldberg, D, Tiemens, BG, Ustun, TB (1999). Outcomes of recognized and unrecognized depression in an international primary care study. General Hospital Psychiatry 21, 97–105.CrossRefGoogle Scholar
Simon, GE, Ludman, EJ (2010). Predictors of early dropout from psychotherapy for depression in community practice. Psychiatric Services 61, 684–689.CrossRefGoogle ScholarPubMed
Simonella, L, Marks, G, Sanderson, K, Andrews, G (2006). Cost-effectiveness of current and optimal treatment for adult asthma. Internal Medicine Journal 36, 244–250.CrossRefGoogle ScholarPubMed
Slade, T, Johnston, A, Teesson, M, Whiteford, H, Burgess, P, Pirkis, J, Saw, S (2009). The Mental Health of Australians 2: Report on the 2007 National Survey of Mental Health and Wellbeing. Commonwealth Department of Health and Ageing: Canberra.Google Scholar
Sonawalla, SB, Farabaugh, AH, Leslie, VM, Pava, JA, Matthews, JD, Fava, M (2002). Early drop-outs, late drop-outs and completers: differences in the continuation phase of a clinical trial. Progress in Neuro-Psychopharmacology and Biological Psychiatry 26, 1415–1419.CrossRefGoogle ScholarPubMed
Strachowski, D, Khaylis, A, Conrad, A, Neri, E, Spiegel, D, Taylor, CB (2008). The effects of cognitive behavior therapy on depression in older patients with cardiovascular risk. Depression and Anxiety 25, E1–E10.CrossRefGoogle ScholarPubMed
van Beljouw, I, Verhaak, P, Cuijpers, P, van Marwijk, H, Penninx, B (2010 a). The course of untreated anxiety and depression and the determinants of poor one-year outcome: a one-year cohort study. BMC Psychiatry 10, 86.CrossRefGoogle ScholarPubMed
van Beljouw, I, Verhaak, P, Prins, M, Cuijpers, P, Penninx, B, Bensing, J (2010 b). Reasons and determinants for not receiving treatment for common mental disorders. Psychiatric Services 61, 250–257.CrossRefGoogle Scholar
Wang, J (2004). A longitudinal population-based study of treated and untreated major depression. Medical Care 42, 543–550.CrossRefGoogle ScholarPubMed
Weisz, JR, Thurber, CA, Sweeney, L, Proffitt, VD, LeGagnoux, GL (1997). Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training. Journal of Consulting and Clinical Psychology 65, 703–707.CrossRefGoogle ScholarPubMed
WHO (2008). The Global Burden of Disease 2004 Update. World Health Organization: Geneva.Google Scholar
Wierzbicki, M, Bartlett, TS (1987). The efficacy of group and individual cognitive therapy for mild depression. Cognitive Therapy and Research 11, 337–342.CrossRefGoogle Scholar
Zimmerman, M, McGlinchey, JB, Posternak, M, Friedman, M, Boerescu, D, Attiullah, N (2006). Discordance between self-reported symptom severity and psychosocial functioning ratings in depressed outpatients: implications for how remission from depression should be defined. Psychiatry Research 141, 185–191.CrossRefGoogle ScholarPubMed
Zimmerman, M, McGlinchey, JB, Posternak, M, Friedman, M, Boerescu, D, Attiullah, N (2008). Remission in depressed outpatients: more than just symptom resolution? Journal of Psychiatric Research 42, 797–801.CrossRefGoogle ScholarPubMed
Supplementary material: File

Whiteford Supplementary Material

Appendix

Download Whiteford Supplementary Material(File)
File 290.7 KB