Depression in general practice attenders. "Caseness", natural history and predictors of outcome

Assessment of 564 routine attenders of 12 Sydney general practices established that 25% of the women and 17% of the men scored as "potential depressives". Thirty-five agreed to an interview and review over 6 months, with 83% of this group initially rating as a "psychiatric case" on the Present State Examination. The sample could be characterized as being chronically depressed (mean duration of 9 months), as predominantly (86%) female, in having relatively stable but dysfunctional relationships, and by having experienced chronic and acute-on-chronic stressors. The degree of which subjects improved in the following 20 weeks could be predicted by their degree of improvement in the first few weeks and as early as the 6th day after assessment. While overall improvement was minimal, several baseline predictors of a better outcome were suggested: a history of having episodic or recurrent episodes, a more severe depression, lower social class, break-up of an intimate relationship as a precipitant, a neutralizing life event and family support. Married subjects and those with young children had a poor outcome.