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Short-term outcome of major depression: I. Comorbidity and severity at presentation as predictors of persistent
I M Goodyer1, J Herbert, S M Secher
1Department of Psychiatry, Cambridge Clinical School, University of Cambridge, England.
Objective:
To determine whether there is a pattern of clinical characteristics at presentation that specifically predicts persistent major depression at 36 weeks follow-up.
Method:
Sixty-eight consecutive cases with a first episode DSM-III-R diagnosis of major depression were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present Episode version and completed the mood and feelings self-report depression questionnaire (MFQ) at presentation and again at 36 weeks.
Results:
At presentation, 63 (93%) had one or more comorbid psychiatric disorders (median = 3). At 36 weeks, 17 (25%) cases were recovered; 17 (25%) continued to meet criteria for one or more psychiatric disorder but not major depression; 34 (50%) still met criteria for DSM-III-R major depression, of whom 25 (73%) had been persistently depressed and 9 (27%) had recovered and subsequently relapsed. Major depression at follow-up was specifically predicted by the additive effect of three features at presentation, comorbid obsessive-compulsive disorder, higher MFQ score, and being older. Comorbid oppositional defiant disorder at presentation was a significant predictor of persistent psychiatric disorder. Individuals with persistent depression (n = 25) were more likely to have a longer duration of illness before presentation.
Conclusion:
Systematic assessment of comorbid psychiatric conditions at initial interview, together with the use, in older subjects, of a self-report questionnaire to determine subjective severity, will provide valid clinical information concerning the potential short-term outcome of major depression.