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J. Kent Sargeant, MD; Martha L. Bruce, PhD; Louis P. Florio, MS; Myrna M. Weissman, PhD

Arch Gen Psychiatry. 1990;47(6):519-526.

Abstract
• Evidence from outcome studies of major depression indicates a high rate of relapse and chronicity, and that prior chronicity, recurrent episodes, and the presence of psychosocial stressors are associated with a poor outcome. However, the generalizability of these findings is limited because most studies have focused on treated samples; thus, these studies may have been biased toward more chronic or severe illnesses. In prospectively surveying a large probability sample of the general population, the Epidemiologic Catchment Area program offers the opportunity to investigate prognosis without selection bias. In this study, the Epidemiologic Catchment Area subjects with a diagnosis of Major Depressive Disorder at first interview (n = 423) were categorized according to their diagnostic status 1 year later. The results confirmed a high rate of nonrecovery, with clinical features associated with a poor outcome that resembled those identified in previous clinical studies. Overall, clinical factors were more important prognostically than were sociodemographic characteristics. However, there was some evidence that a poorer outcome in older women may partially explain the greater female prevalence of depression in the community.

Author Affiliations
From the Department of Psychiatry, University of British Columbia, Vancouver, Canada (Dr Sargeant), the Department of Epidemiology and Public Health, School of Medicine, Yale University, New Haven, Conn (Dr Bruce and Mr Florio), and the Division of Clinical-Genetic Epidemiology, New York State Psychiatric Institute and College of Physicians, Columbia University, New York, NY (Dr Weissman).

Footnotes
Accepted for publication June 30, 1989.

Reprint requests to Department of Psychiatry, University of British Columbia, 2255 Westbrook Mall, Vancouver, British Columbia, Canada V6T 2A1 (Dr Sargeant).

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