title: Recurrence of major depressive disorder and its predictors in the general population: results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS).
abstract: BACKGROUND
  Knowledge of the risk of recurrence after recovery from major depressive disorder (MDD) in the general population is scarce.
  
  
  METHODS
  Data were derived from 687 subjects in the general population with a lifetime DSM-III-R diagnosis of MDD but without a current major depressive episode (MDE) or dysthymia. Participants had to be at least 6 months in remission, and were recruited from The Netherlands Mental Health Survey and Incidence Study (NEMESIS), using the composite international diagnostic interview (CIDI). Recency and severity of the last MDE were assessed retrospectively at baseline. Recurrence of MDD was measured prospectively during the 3-year follow-up. Kaplan-Meier survival curves were used to measure time to recurrence. Determinants of time to recurrence were analyzed using proportional hazard models.
  
  
  RESULTS
  The estimated cumulative recurrence of MDD was 13.2% at 5 years, 23.2% at 10 years and 42.0% at 20 years. In bivariate analysis, the following variables predicted a shorter time to recurrence: younger age, younger age of onset, higher number of previous episodes, a severe last depressive episode, negative youth experiences, ongoing difficulties before recurrence and high neuroticism. Multivariably, younger age, a higher number of previous episodes, a severe last depressive episode, negative youth experiences and ongoing difficulties remained significant.
  
  
  CONCLUSIONS
  In this community sample, the long-term risk of recurrence was high, but lower than that found in clinical samples. Subjects who had had an MDE had a long-term vulnerability for recurrence. Factors predicting recurrence included illness- and stress-related factors.
authors.affiliation: Pro Persona, Institute for Mental Health Care, Ede, The Netherlands. f.hardeveld@propersona.nl
authors.forename: F
authors.initials: F
authors.lastname: Hardeveld
authors.forename: J
authors.initials: J
authors.lastname: Spijker
authors.forename: R
authors.initials: R
authors.lastname: De Graaf
authors.forename: W A
authors.initials: WA
authors.lastname: Nolen
authors.forename: A T F
authors.initials: AT
authors.lastname: Beekman
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010551:Personality / Q000502:physiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult