Clinical factors associated with relapse in primary care patients with chronic or recurrent depression.
BACKGROUND
Because in most patients depression is a relapsing/remitting disorder, finding clinical factors associated with risk of relapse is important. The majority of patients with depression are treated in primary care settings, but few previous studies have examined predictors of relapse in primary care patients with recurrent or chronic depression.


METHODS
Data from a cohort of 386 primary care patients in a clinical trial were analyzed for clinical and demographic predictors of relapse over a one-year post-study observational period. Patients were selected for a high risk of relapse, based on a history of either 3 previous depressive episodes or dysthymia, and enrolled in a randomized trial of relapse prevention.


RESULTS
Factors found to be associated with significantly higher risk of relapse included poorer medication adherence in the 30 days prior to the trial, lower self-efficacy to manage depression, and higher scores on the Child Trauma Questionnaire.


CONCLUSIONS
Use of a sample of limited diversity taken from a clinical trial, and use of retrospective information from patients with potential for recall bias.


CONCLUSIONS
The findings of this report suggest specific risk factors to be targeted in depression relapse prevention interventions. It is encouraging that two of the factors associated with increased risk of relapse, self-efficacy and medication adherence have been seen to improve with the intervention utilized in the primary care trial from which the studied cohort was drawn.
Gopinath
Shamin
S
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. shamin@u.washington.edu
Katon
Wayne J
WJ
Russo
Joan E
JE
Ludman
Evette J
EJ
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D019263:Dysthymic Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010552:Personality Assessment; D010555:Personality Inventory; D011320:Primary Health Care; D012307:Risk Factors; D055502:Secondary Prevention; D020377:Self Efficacy; D012917:Social Adjustment
D000928:Antidepressive Agents