A Patient Stratification Approach to Identifying the Likelihood of Continued Chronic Depression and Relapse Following Treatment for Depression

Abstract

Background: Subgrouping methods have the potential to support treatment decision making for patients with depression. Such approaches have not been used to study the continued course of depression or likelihood of relapse following treatment. Method: Data from individual participants of seven randomised controlled trials were analysed. Latent profile analysis was used to identify subgroups based on baseline characteristics. Associations between profiles and odds of both continued chronic depression and relapse up to one year post-treatment were explored. Differences in outcomes were investigated within profiles for those treated with antidepressants, psychological therapy, and usual care. Results: Seven profiles were identified; profiles with higher symptom severity and long durations of both anxiety and depression at baseline were at higher risk of relapse and of chronic depression. Members of profile five (likely long durations of depression and anxiety, moderately-severe symptoms, and past antidepressant use) appeared to have better outcomes with psychological therapies: antidepressants vs. psychological therapies (OR (95% CI) for relapse = 2.92 (1.24–6.87), chronic course = 2.27 (1.27–4.06)) and usual care vs. psychological therapies (relapse = 2.51 (1.16–5.40), chronic course = 1.98 (1.16–3.37)). Conclusions: Profiles at greater risk of poor outcomes could benefit from more intensive treatment and frequent monitoring. Patients in profile five may benefit more from psychological therapies than other treatments.

Six-year prognosis of anxiety and depression caseness and their comorbidity in a prospective population-based adult sample

“…Comorbidity between anxiety and depression has been reported to have a poorer recovery prognosis than depression alone [ 8 , 12 , 13 ], which the present recovery results for three-year associations support (36.8% for comorbidity vs 59.4% for depression). Furthermore, in accordance with earlier studies [ 29 – 31 ], relapse in depression was more common in comorbid anxiety (9 cases) than without comorbid anxiety (1 case). Global prevalence and incidence rates for depression are quite similar, whereas the prevalence rate for anxiety is much higher than the incidence rate, indicating that anxiety is a more persistent condition than depression [ 1 ].…”

Socioeconomic Indicators of Treatment Prognosis for Adults With Depression

“…This may be particularly important at present given concerns of increased vulnerability owing to the effect of the COVID-19 pandemic on employment and housing . Future studies may investigate the optimal order with which to offer support for employment or housing, as well as more intensive conventional treatment strategies, including longer follow-up, for the management of depression in adults that present with clinical indicators of poorer prognosis . At a public health level, knowing that socioeconomic disadvantage is associated with a worse depression treatment prognosis suggests that reducing socioeconomic inequalities may improve mental health through an association with treatment prognosis as well as a reduction in the incidence of mental health problems …”

Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis

“…In anxiety disorders, after remission, 14-58% of patients experienced a relapse [5,8,12,20,21], with similar relapse rates for subtypes of anxiety disorders [5]. Likewise, with regard to major depressive disorder (MDD), 18-77% of patients experienced a relapse [22][23][24][25][26][27][28].…”