Predictors of early recovery from major depression among persons admitted to community-based clinics: an observational study.
BACKGROUND
Twenty years have elapsed since the National Institute of Mental Health Collaborative Depression Study reported on the early course and treatment of major depression within the mental health sector. Using similar methods, an observational study was conducted to assess relationships between initial depression severity, personality dysfunction and other baseline characteristics, subsequent treatment, and 3-month outcomes among persons admitted to public and voluntary sector outpatient clinics, including 1 academic program.


METHODS
A 2-stage sampling technique was used to recruit subjects (N = 165) diagnosed by the Structured Clinical Interview for DSM-IV, Patient Version, as having a major depression episode. Sociodemographic and clinical characteristics were assessed at admission. Data on treatment and outcome were obtained at 3 months using structured instruments from the Longitudinal Interview Follow-up Evaluation. Logistic regression was used to assess hypothesized predictors of early recovery. Analyses were carried out in the total sample and after dichotomizing subjects by baseline depression severity.


RESULTS
Fifty (30.3%) of the 165 subjects met recovery criteria. Less than half of the subjects (45%) met criteria for adequate pharmacotherapy. Less severe depression, having received adequate antidepressant treatment, female sex, and being married independently predicted early recovery. In the more depressed subgroup, early recovery was associated with female sex. Among less severely depressed subjects, high personality dysfunction scores and being married were significant predictors.


CONCLUSIONS
Initial depression severity and receiving adequate pharmacotherapy predict early recovery in individuals with major depression seeking outpatient treatment. A minority of persons receive intensive antidepressant treatment. Less severe personality dysfunction and being married predicts early recovery among persons with less severe depression.
Meyers
Barnett S
BS
Department of Psychiatry, Weill Medical College of Cornell University, White Plains, NY, USA. bmeyers@med.cornell.edu
Sirey
Jo Anne
JA
Bruce
Martha
M
Hamilton
Mimi
M
Raue
Patrick
P
Friedman
Steven J
SJ
Rickey
Cynthia
C
Kakuma
Tatsu
T
Carroll
Melissa K
MK
Kiosses
Dimitris
D
Alexopoulos
George
G
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003155:Community Mental Health Centers; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010349:Patient Compliance; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents