A comprehensive model of predictors of persistence and recurrence in adults with major depression: Results from a national 3-year prospective study

Abstract

Identifying predictors of persistence and recurrence of depression in individuals with a major depressive episode (MDE) poses a critical challenge for clinicians and researchers. We develop using a nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N=34,653), a comprehensive model of the 3-year risk of persistence and recurrence in individuals with MDE at baseline. We used structural equation modeling to examine simultaneously the effects of four broad groups of clinical factors on the risk of MDE persistence and recurrence: 1) severity of depressive illness, 2) severity of mental and physical comorbidity, 3) sociodemographic characteristics and 4) treatment-seeking behavior. Approximately 16% and 21% of the 2,587 participants with an MDE at baseline had a persistent MDE and a new MDE during the 3-year follow-up period, respectively. Most independent predictors were common for both persistence and recurrence and included markers for the severity of the depressive illness at baseline (as measured by higher levels on the general depressive symptom dimension, lower mental component summary scores, prior suicide attempts, younger age at onset of depression and greater number of MDEs), the severity of comorbidities (as measured by higher levels on dimensions of psychopathology and lower physical component summary scores) and a failure to seek treatment for MDE at baseline. This population-based model highlights strategies that may improve the course of MDE, including the need to develop interventions that target multiple psychiatric disorders and promotion of treatment seeking to increase access to timely mental health care.

Recurrence and chronicity of major depressive disorder and their risk indicators in a population cohort

“…Similar to previous studies , childhood abuse, higher number of previous depressive episodes and severe depression at baseline were significantly related to shorter time to recurrence. The finding that lower mental functioning was significantly related to shorter time to recurrence also confirms earlier research .…”

“…The finding that lower age was significantly related to shorter time to recurrence confirms earlier population‐based , but not clinical and primary care research (e.g. ).…”

“…Three of the four abovementioned population studies investigated risk indicators for recurrence (see Appendix ). In two of them, recurrence was predicted by younger age, younger age at onset and higher number of previous episodes . In one study, recurrence was also predicted by a severe last depressive episode, negative youth experiences and high neuroticism and in the other study by worse mental functioning, several depressive symptoms and treatment seeking for depression .…”

“…In two of them, recurrence was predicted by younger age, younger age at onset and higher number of previous episodes . In one study, recurrence was also predicted by a severe last depressive episode, negative youth experiences and high neuroticism and in the other study by worse mental functioning, several depressive symptoms and treatment seeking for depression . Mixed findings or mainly non‐significant findings concerned the role of negative life events, psychiatric comorbidity and family history of depression in predicting recurrence.…”

“…). Despite that there is some evidence that functioning during remission could play a role in predicting recurrence , this association was not investigated in the other population studies . Physical health has also not been systematically assessed so far.…”