Predictive effects of previous episodes on the risk of recurrence in depressive and bipolar disorders

Abstract

Findings from several studies have suggested that the risk of recurrence increases with the number of previous episodes in depressive and bipolar disorders. However, a comprehensive and critical review of the literature published during the past century shows that in several previous studies, a progressive course of episodes may have been falsely shown, mainly because of various kinds of biases and because these studies have not considered individual heterogeneity in their analyses. Nevertheless, four recent studies, including two nationwide register studies from Denmark, a prospective 15-year multicenter study from the United States, and a prospective lifelong study from Zurich, Switzerland, generally have taken these drawbacks and pitfalls into account in the design and handling of data. In all four studies, an effect of episodes was found in depressive (four studies) and bipolar (three studies) disorders. It is concluded that the average risk of recurrence increases with the number of episodes in depressive and in bipolar affective disorders. Nevertheless, the course of illness in unipolar and bipolar disorders is heterogeneous, and the effect of previous episodes and its interrelation with other risk factors on the risk of relapse and recurrence warrants additional research.

The Revolving Door Phenomenon Revisited: Time to Readmission in 17’415 Patients with 37’697 Hospitalisations at a German Psychiatric Hospital

“…Therefore analyses on the reasons for rehospitalisation have been performed in numerous studies [8] [9] [10] [11] [12] [13]. Accurate identification of risk factors for rehospitalisation is highly relevant for several reasons.…”

“…If, as a first approach to this problem, the indenture number of a single hospitalisation is taken into account, time to readmission seems to fall shorter with higher numbers of re-hospitalisations in patients with schizophrenic disorders [16], as well as with affective disorders [10]. This has been interpreted as “acceleration of the revolving door” throughout an individual treatment career.…”

“…Indeed, a seemingly progressive course of schizophrenia can be explained as a selection artifact, if patients’ individual “frailties” for readmission are taken into account and integrated into the statistical analysis [17] [18]. For patients with affective disorders, both individual frailties and an acceleration effect over course of illness have been reported as influential [19] [10]. These individual frailties may reflect demographic characteristics, individual illness severity as well as individual variations of the treatment process and their social situation [10] [13] [12] [20].…”

“…For patients with affective disorders, both individual frailties and an acceleration effect over course of illness have been reported as influential [19] [10]. These individual frailties may reflect demographic characteristics, individual illness severity as well as individual variations of the treatment process and their social situation [10] [13] [12] [20]. Therefore, the study of readmission risk must take into account the individual susceptibility towards readmission.…”

Competition Effects in Visual Cortex Between Emotional Distractors and a Primary Task in Remitted Depression

“…This high-risk population (i.e., women who had a fully remitted episode of MDD within the past five years) is at risk for two key reasons: (i) women have twice the rate of MDD compared to men (26–28) and (ii) over 60% of individuals who develop MDD will experience at least one recurrent episode within 5 years of remission (29). Based on previous research using behavioral measures of attention (6–10), we hypothesized that rMDD women, compared to their never-depressed counterparts, would display difficulty inhibiting attention to negative distractors.…”