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Predictors of Early Recovery From Major Depression Among Persons Admitted to Community-Based Clinics
An Observational Study
Barnett S. Meyers, MD;
Jo Anne Sirey, PhD;
Martha Bruce, PhD;
Mimi Hamilton, PhD;
Patrick Raue, PhD;
Steven J. Friedman, MS;
Cynthia Rickey, MS;
Tatsu Kakuma, PhD;
Melissa K. Carroll;
Dimitris Kiosses, PhD;
George Alexopoulos, MD
Arch Gen Psychiatry. 2002;59:729-735.
Background Twenty years have elapsed since the National Institute of Mental Health
Collaborative Depression Study reported on the early course and treatment
of major depression within the mental health sector. Using similar methods,
an observational study was conducted to assess relationships between initial
depression severity, personality dysfunction and other baseline characteristics,
subsequent treatment, and 3-month outcomes among persons admitted to public
and voluntary sector outpatient clinics, including 1 academic program.
Methods A 2-stage sampling technique was used to recruit subjects (N = 165)
diagnosed by the Structured Clinical Interview for DSM-IV, Patient Version, as having a major depression episode. Sociodemographic
and clinical characteristics were assessed at admission. Data on treatment
and outcome were obtained at 3 months using structured instruments from the
Longitudinal Interview Follow-up Evaluation. Logistic regression was used
to assess hypothesized predictors of early recovery. Analyses were carried
out in the total sample and after dichotomizing subjects by baseline depression
severity.
Results Fifty (30.3%) of the 165 subjects met recovery criteria. Less than half
of the subjects (45%) met criteria for adequate pharmacotherapy. Less severe
depression, having received adequate antidepressant treatment, female sex,
and being married independently predicted early recovery. In the more depressed
subgroup, early recovery was associated with female sex. Among less severely
depressed subjects, high personality dysfunction scores and being married
were significant predictors.
Conclusions Initial depression severity and receiving adequate pharmacotherapy predict
early recovery in individuals with major depression seeking outpatient treatment.
A minority of persons receive intensive antidepressant treatment. Less severe
personality dysfunction and being married predicts early recovery among persons
with less severe depression.
From the Department of Psychiatry, Weill Medical College of Cornell
University, White Plains, NY. Dr Meyers is now with the Departments of Psychiatry,
Weill Medical College of Cornell University and New York–Presbyterian
Hospital, White Plains.
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