Predicting recovery from episodes of major depression.
BACKGROUND
This study examined psychosocial functioning as a predictor of recovery from episodes of unipolar major depression.


METHODS
231 subjects diagnosed with major depressive disorder according to Research Diagnostic Criteria were prospectively followed for up to 20 years as part of the NIMH Collaborative Depression Study. The association between psychosocial functioning and recovery from episodes of unipolar major depression was analyzed with a mixed-effects logistic regression model which controlled for cumulative morbidity, defined as the amount of time ill with major depression during prospective follow-up. Recovery was defined as at least eight consecutive weeks with either no symptoms of major depression, or only one or two symptoms at a mild level of severity.


RESULTS
In the mixed-effects model, a one standard deviation increase in psychosocial impairment was significantly associated with a 22% decrease in the likelihood of subsequent recovery from an episode of major depression (OR=0.78, 95% CI: 0.74-0.82, Z=-3.17, p<0.002). Also, a one standard deviation increase in cumulative morbidity was significantly associated with a 61% decrease in the probability of recovery (OR=0.3899, 95% CI: 0.3894-0.3903, Z=-7.21, p<0.001).


CONCLUSIONS
The generalizability of the study is limited in so far as subjects were recruited as they sought treatment at academic medical centers. The analyses examined the relationship between psychosocial functioning and recovery from major depression, and did not include episodes of minor depression. Furthermore, this was an observational study and the investigators did not control treatment.


CONCLUSIONS
Assessment of psychosocial impairment may help identify patients less likely to recover from an episode of major depression.
Solomon
David A
DA
Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903-4970, United States. DASolomon@Lifespan.org
Leon
Andrew C
AC
Coryell
William
W
Mueller
Timothy I
TI
Posternak
Michael
M
Endicott
Jean
J
Keller
Martin B
MB
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012720:Severity of Illness Index; D012917:Social Adjustment; D016896:Treatment Outcome
D011619:Psychotropic Drugs