Kirjoittaja Psykopatologia » 05.04.2014 01:01
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full remission of mdd, and periods of substance abuse, suicide attempts, and sick
leaves and disability pension were examined with a life-chart.
Patients with lifetime mdd (123/137) spent 34% of follow-up time of the five
years in mdEs, 24% in partial remission and only 42% in full remission. nine in ten
achieved at least partial remission and two-thirds reached full remission. Baseline
severity of depression and substance use comorbidity predicted time spent in mdEs:
a rise in Hamilton Rating Scale for depression (HAmd) score of ten at baseline
predicted 14 months and comorbid substance use disorder 25 months more time in
mdEs. one-half of those who achieved partial remission and one-third of those who
reached full remission were having at least one recurrence. The recurrences were
predicted by baseline personality disorders. The time from remission to recurrence
was predicted by baseline generalized anxiety disorder and somatoform disorder.
one-tenth of all patients attempted suicide one to three times during five years.
The incidence rate varied robustly depending on the level of depression, being 0
per 1000 patient-years during full remission, 5.8 per 1000 patient-years during
partial remission and 107 per 1000 patient-years during mdEs. Although a history
of suicide attempts and substance use disorder also indicated the risk, duration of
mdEs was the central factor determining overall long-term risk.
In the whole cohort, level of functioning and work ability were strongly
associated with time spent depressed and current severity of depression. patients
who belonged to the labour force at baseline spent one-third of the follow-up off
work due to depression; two-thirds were granted sick leave, and one-tenth a disability
pension due to depression. Longer duration of depression, comorbid disorders and
having received social assistance predicted dropping out from work.
A quarter of all patients suffered from concurrent borderline personality
disorder (Bpd) at the study entry. This proportion diminished to one-fifth in
five years. Comorbid anxiety and substance use disorders were common among
them. Concurrent Bpd increased the severity and duration of depression, suicidal
behaviour, unemployment and economic difficulties. These patients comprised a
particularly comorbid, chronic and disabled group.
This naturalistic prospective cohort study of primary care patients with
depressive disorders revealed often slow and incomplete recovery and a common
recurrent course, which needs to be taken into account when developing services.
While the severity of depression predicts poor outcome, the use of measurement
scales is warranted when planning and monitoring treatment. Comorbidity,
concurrent substance use disorder, anxiety disorders, somatoform disorder and
Bpd all need to be taken into account in clinical practice guidelines. duration of
depression appears most decisive for suicide attempts among primary care patients
with depression. Efforts should focus on the continuity of care.
Keywords: primary care, depression, follow-up, outcome, comorbidity, suicide
attempts, disability, employment, borderline personality disorder
