Risk Factors Associated with Relapse in Major Depressive Disorder in Primary Care Patients: A Systematic Review

Area of Science:

• Psychiatry
• Clinical Psychology
• Primary Care Medicine

Background:

• Major Depressive Disorder (MDD) is characterized by high recurrence rates.
• The majority of MDD patients receive treatment within the Primary Care (PC) setting.
• Understanding relapse predictors in PC is essential for effective long-term management.

Purpose of the Study:

• To systematically identify risk factors associated with the relapse of Major Depressive Disorder (MDD) in primary care settings.
• To synthesize evidence from existing literature to inform clinical practice and future research.
• To provide a comprehensive overview of factors influencing MDD recurrence.

Main Methods:

• A systematic review was conducted adhering to PRISMA guidelines.
• Literature searches were performed across major databases: PsycINFO, PubMed, Web of Science, and ScienceDirect.
• Studies published between 1978 and 2019 were included.

Main Results:

• Twelve distinct risk factors for MDD relapse were identified across eight eligible studies.
• Higher relapse frequency was associated with increased neuroticism, disability, episode severity, childhood abuse, and comorbidity.
• Lower relapse risk was linked to higher extraversion, self-esteem, emotional/physical functioning, and better adherence to antidepressant medication (ADM).
• Combination treatments (ADM with CBT/psychoeducation) and mindfulness-based cognitive therapy showed promise in reducing relapse.

Conclusions:

• Several risk factors for MDD relapse in primary care have been identified, despite study heterogeneity.
• Further research, particularly randomized controlled trials, is necessary to solidify these findings and guide interventions.
• Targeting identified risk factors and optimizing treatment strategies are key to reducing MDD recurrence.