Major depressive disorder (MDD) is often a recurrent disorder. Predicting recurrence is clinically important as maintenance treatment might be necessary in those circumstances. Subclinical residual symptoms after an episode and the number of previous episodes are considered to be the most important predictors.Most studies in this area were done among patients accessing specialist mental health services.
F. Hardeveld, J. Spijker1, R. De Graaf, W. A. Nolen and A. T. F. Beekman from Netherlands studied the predictors in a general population sample of dutch adults selected using a multistage, stratified, random sampling procedure and interviewed either over telephone or directly (using CIDI) at baseline, one year and three years.7076 persons were eligible for inclusion, with a response rate of 70%. 4796 (68%) were interviewed at all three waves.
Study sample: (NEMESIS study) 1153 respondents had a life time diagnosis of depression at baseline. Those with ongoing episodes were excluded and the remaining 836 individuals formed the sample who were at risk of recurrence. of this 836 , 687 were re interviewed at one year and 590 at three years. 687 respondents, having at least one reinterview forms the study sample.
Results: Risk for recurrence increase over time. Cumulative recurrence percentage was 2.5% at one year, 23.2% at 10 yrs, and 42% at 20 yrs.Predictors of shorter time to recurrence: younger age, a greater number of previous episodes, a severe last depressive episode, negative youth experiences and ongoing difficulties. Female gender was not associated with higher recurrence. Risk of recurrence is less compared to clinical samples. ( 85% in 15 yrs ,Mueleer et al 1999).
Limitations: Last depressive episode was diagnosed retrospectively using CIDI and hence the age of onset and onset of last episode may not reflect true picture. Respondents were included only if they had a duration of remission of at least 6 months, implying that respondents with a shorter time to recurrence were not included. Subclinical depressive symptoms- a well known predictor was not assessed.
Comments: In general , a more severe disorder ( that express early in age in a severe form with multiple episodes in past) predicts higher recurrence.Those with high risk of recurrence should receive more attention in terms of continued use of antidepressants or psychological/social interventions. These predictors are in general similar to risk factors identified from clinic samples.
Summary of the article:
Recurrence of major depressive disorder and its predictors in the general population:results from The Netherlands Mental Health Survey and Incidence Study (NEMESIS).Hardeveld F, Spijker J, De Graaf R, Nolen WA, Beekman AT.Psychol Med. 2013 Jan;43(1):39-48.