title: Five-year outcome of major depressive disorder in primary health care.
abstract: BACKGROUND
  Primary health care provides treatment for most patients with depression. Despite their importance for organizing services, long-term course of depression and risk factors for poor outcome in primary care are not well known.
  
  
  METHODS
  In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients representing primary care patients in a Finnish city was screened for depression with the Primary Care Evaluation of Mental Disorders. SCID-I/P and SCID-II interviews were used to diagnose Axis I and II disorders. The 137 patients with DSM-IV depressive disorder were prospectively followed up at 3, 6, 18 and 60 months. Altogether, 82% of patients completed the 5-year follow-up, including 102 patients with a research diagnosis of major depressive disorder (MDD) at baseline. Duration of the index episode, recurrences, time spent in major depressive episodes (MDEs) and partial or full remission were examined with a life-chart.
  
  
  RESULTS
  Of the MDD patients, 70% reached full remission, in a median time of 20 months. One-third had at least one recurrence. The patients spent 34% of the follow-up time in MDEs, 24% in partial remission and 42% in full remission. Baseline severity of depression and substance use co-morbidity predicted time spent in MDEs.
  
  
  CONCLUSIONS
  This prospective, naturalistic, long-term study of a representative cohort of primary care patients with depression indicated slow or incomplete recovery and a commonly recurrent course, which need to be taken into account when developing primary care services. Severity of depressive symptoms and substance use co-morbidity should be systematically evaluated in planning treatment.
authors.affiliation: National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland.
authors.forename: K A
authors.initials: KA
authors.lastname: Riihimäki
authors.affiliation: National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland.
authors.forename: M S
authors.initials: MS
authors.lastname: Vuorilehto
authors.affiliation: National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland.
authors.forename: T K
authors.initials: TK
authors.lastname: Melartin
authors.affiliation: National Institute for Health and Welfare, Mood, Depression and Suicidal Behaviour Research Unit, Helsinki, Finland.
authors.forename: E T
authors.initials: ET
authors.lastname: Isometsä
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012008:Recurrence; D055815:Young Adult