Clinical and psychosocial origins of chronic depressive episodes. II. A patient enquiry.
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.


METHODS
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.
Brown
G W
GW
Department of Social Policy and Social Science, Royal Holloway College, University of London.
Harris
T O
TO
Hepworth
C
C
Robinson
R
R
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D002649:Child Abuse / Q000175:diagnosis / Q000706:statistics & numerical data; D002650:Child Abuse, Sexual / Q000175:diagnosis / Q000706:statistics & numerical data; D002908:Chronic Disease; D003631:Day Care, Medical; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007398:Interpersonal Relations; D008016:Life Change Events; D008875:Middle Aged; D011567:Psychiatric Department, Hospital; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012944:Social Support