Estimating remission from untreated major depression: a systematic review and meta-analysis

2012 ◽  
Vol 43 (8) ◽  
pp. 1569-1585 ◽  
Author(s):  
H. A. Whiteford ◽  
M. G. Harris ◽  
G. McKeon ◽  
A. Baxter ◽  
C. Pennell ◽  
...  
Keyword(s):  
Primary Care ◽  
Major Depression ◽  
Meta Analysis ◽  
Severe Depression ◽  
Spontaneous Remission ◽  
Lower Probability ◽  
Wait List ◽  
Observational Cohort ◽  
Study Type

BackgroundFew studies have examined spontaneous remission from major depression. This study investigated the proportion of prevalent cases of untreated major depression that will remit without treatment in a year, and whether remission rates vary by disorder severity.MethodWait-list controlled trials and observational cohort studies published up to 2010 with data describing remission from untreated depression at ⩽2-year follow-up were identified. Remission was defined as rescinded diagnoses or below threshold scores on standardized symptom measures. Nineteen studies were included in a regression model predicting the probability of 12-month remission from untreated depression, using logit transformed remission proportion as the dependent variable. Covariates included age, gender, study type and diagnostic measure.ResultsWait-listed compared to primary-care samples, studies with longer follow-up duration and older adult compared to adult samples were associated with lower probability of remission. Child and adolescent samples were associated with higher probability of remission. Based on adult samples recruited from primary-care settings, the model estimated that 23% of prevalent cases of untreated depression will remit within 3 months, 32% within 6 months and 53% within 12 months.ConclusionsIt is undesirable to expect 100% treatment coverage for depression, given many will remit before access to services is feasible. Data were drawn from consenting wait-list and primary-care samples, which potentially over-represented mild-to-moderate cases of depression. Considering reported rates of spontaneous remission, a short untreated period seems defensible for this subpopulation, where judged appropriate by the clinician. Conclusions may not apply to individuals with more severe depression.

scholarly journals Quality of life, diagnosis, and treatment of patients with major depression: a prospective cohort study in primary care

2011 ◽  
Vol 33 (3) ◽  
pp. 245-251 ◽  
Author(s):  
Ana Flávia Barros da Silva Lima ◽  
Marcelo Pio de Almeida Fleck
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Cohort Study ◽  
Major Depression ◽  
Antidepressant Treatment ◽  
Epidemiologic Studies ◽  
World Health ◽  
World Health Organization Quality

OBJECTIVE: To describe the demographic and clinical characteristics, adequacy of antidepressant treatment, and changes in quality of life of patients with major depression receiving follow-up care from primary care centers. METHOD: A cohort study was performed in which major depression patients were followed-up over a nine-month period. Several evaluation instruments were used, including the World Health Organization Quality of Life and the Quality of Life-Depression, Centers for Epidemiologic Studies-Depression questionnaires. RESULTS: The sample comprised 179 individuals, mostly female (73%), with a mean age of 38 years and mean education of 9 years. At the end of the follow-up period, 42% of the individuals still presented with major depression, 25% had complete symptom remission, and only 9% were properly treated with antidepressants. In relation to quality of life, there were significant differences especially between baseline and after nine months in almost all measures. CONCLUSION: This study demonstrated that depressive symptoms are poorly recognized and that treatment is often inadequate for patients followed-up in primary care units in the south of Brazil. Most of the patients continued to have symptoms of depression over the nine-month period which were associated with impaired quality of life.

Severe Depression Following Recovery From Thrombotic Thrombocytopenic Purpura (TTP)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 366-366 ◽  
Author(s):  
Cassandra C. Deford ◽  
Lauren H. Schwartz ◽  
Jedidiah J. Perdue ◽  
Jessica A. Reese ◽  
Johanna A. Kremer Hovinga ◽  
...  
Keyword(s):  
Major Depression ◽  
Relative Frequency ◽  
Severe Depression ◽  
Major Depressive ◽  
Psychiatric Interview ◽  
Long Term Follow Up ◽  
Adamts13 Deficiency ◽  
Initial Episode

Abstract Abstract 366 Introduction Recovery from an acute episode of TTP is typically assumed to be complete. However patients from the Oklahoma TTP-HUS Registry have often described persistent problems with memory, concentration, and endurance. Our previous studies have documented long-term deficits in quality-of-life and cognitive functioning. We have also observed an unexpectedly high frequency of severe depression. Therefore we documented the relative frequency of severe depression during long-term follow-up and compared the relative frequency of severe depression in our patients to US and Oklahoma population data. Methods We included all Oklahoma TTP-HUS Registry patients whose initial episode was associated with severe ADAMTS13 deficiency (<10%), 1995–2010, and who were alive in 2004 when our psychiatric evaluations began. Patients completed the Beck Depression Inventory-II (BDI-II) 1–5 times from 2004–2011. The BDI-II is a self-report measure consisting of 21 items. Scores are interpreted as suggesting no/minimal, mild, moderate or severe depression. In 2011, patients who had BDI-II scores indicating moderate or severe depression on at least 1 evaluation had a structured psychiatric interview to support the diagnosis of depression. In 2012, all patients were asked to complete an 8-item measure, the Patient Health Questionnaire-8 (PHQ-8). The relative frequency of patients whose PHQ-8 scores indicated major depression were compared to the relative frequency of major depression determined by the PHQ-8 in the Oklahoma and US populations in the most recent Behavioral Risk Factor Surveillance System (BRFSS) data, 2006 and 2008. Results Of 68 patients who had severe ADAMTS13 deficiency at the time of their initial episode of TTP, 52 were alive in 2004; 47 (90%) were evaluated by the BDI-II. Fifteen (32%) of the 47 patients had scores suggesting severe depression on at least 1 evaluation; 12 were alive in 2011 and 10 (83%) of these 12 patients underwent a structured psychiatric interview; 9 met criteria for a major depressive disorder based on this diagnostic interview. Seven (15%) of the 47 patients had scores indicating only moderate depression; 4 (57%) of these 7 patients underwent a structured psychiatric interview; 1 (25%) met criteria for a major depressive disorder. Thirty-seven (88%) of 42 surviving patients in 2012 were evaluated by the PHQ-8 6.3 years (median) after their initial episode; 7 (18.9%, 95% CI, 8.0–35.2) had scores suggesting major depression, which is significantly greater than the prevalence of major depression in the US (3.4%) and Oklahoma (3.5%). The greater relative frequency of major depression was consistent across demographic subgroups. Conclusion The relative frequency of severe depression is increased in patients during long-term follow-up after recovery from TTP. Recognition and appropriate management of this clinically important health problem are critical components of the care of patients who have survived acute episodes of TTP. Disclosures: Kremer Hovinga: Baxter Healthcare: Consultancy, Research Funding. Terrell:Amgen, Inc.: Consultancy; Baxter, Inc.: Consultancy. George:Alexion, Inc.: Consultancy; Amgen, Inc.: Consultancy, PI for clinical trial involving romiplostim, PI for clinical trial involving romiplostim Other, Research Funding; Baxter, Inc.: Consultancy.

scholarly journals Major depression and its correlates in primary care settings in six countries

2005 ◽  
Vol 186 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Marcelo Pio De Almeida Fleck ◽  
Gregory Simon ◽  
Helen Herrman ◽  
Donald Bushnell ◽  
Mona Martin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Logistic Regression ◽  
Major Depression ◽  
Complete Remission ◽  
Life Events ◽  
Scale Score ◽  
Depression Scale

BackgroundFew published studies address depression outcomes in primary care from a cross-cultural perspective.AimsTo define baseline factors associated with 9-month clinical outcome: across six countries.MethodAdults meeting criteria for current major depression were recruited from primary care clinics in Australia, Brazil, Israel, Spain, Russia and the USA; 968 patients were assessed at the 9-month follow-up. Predictors of complete remission were examined using logistic regression with a hierarchical model.ResultsRates of complete remission in the six sites ranged from 25% to 48%. Logistic regression using pooled data showed that education, key life events and the Quality of Life Depression Scale score at baseline were the final predictors of complete remission, adjusting for centres, socio-demographic data, severity of depression, comorbidity and general quality of life. Variation in predictors across sites was not statistically significant.ConclusionsThe two major findings of this study were the low proportion of people achieving complete remission at follow-up across the six sites, and that some baseline characteristics (education, Quality of Life Depression Scale score and key life events) are modest predictors of outcome in depression.

scholarly journals Differential mortality rates in major and subthreshold depression: meta-analysis of studies that measured both

2013 ◽  
Vol 202 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Pirn Cuijpers ◽  
Nicole Vogelzangs ◽  
Jos Twisk ◽  
Annet Kleiboer ◽  
Juan Li ◽  
...  
Keyword(s):  
Major Depression ◽  
Excess Mortality ◽  
Meta Analysis ◽  
Population Attributable Fraction ◽  
Attributable Fraction ◽  
Differential Mortality ◽  
Bibliographic Databases ◽  
Subthreshold Depression ◽  
The Difference

BackgroundAlthough the association between depression and excess mortality has been well established, it is not clear whether this is greater in major depression than in subthreshold depression.AimsTo compare excess mortality in major depression with that in subthreshold depression.MethodWe searched bibliographic databases and included prospective studies in which both major and subthreshold depression were examined at baseline and mortality was measured at follow-up.ResultsA total of 22 studies were included. People with major depression had a somewhat increased chance of dying earlier than people with subthreshold depression but this difference was not significant, although there was a trend (relative risk 1.13, 95% CI 0.98-1.30, P=0.1). The population attributable fraction was 7% for major depression and an additional 7% for subthreshold depression.ConclusionsAlthough excess mortality may be somewhat higher in major than in subthreshold depression, the difference is small and the overall impact on excess mortality is comparable.

scholarly journals Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e034886 ◽  
Author(s):  
Daniel J Grint ◽  
Helen I McDonald ◽  
Jemma L Walker ◽  
Gayatri Amirthalingam ◽  
Nick Andrews ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Analysis ◽  
Care Staff ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Varicella Zoster ◽  
Related Disease ◽  
Observational Cohort ◽  
Primary Care Staff

ObjectivesTo investigate the safety of live attenuated varicella zoster vaccination when administered to immunosuppressed individuals.DesignProspective observational cohort study.SettingThe study used anonymised data from the Clinical Practice Research Datalink (CPRD), comprising a representative sample of routinely collected primary care data in England between 2013 and 2017 and and linked Hospital Episode Statistics data.Participants168 767 individuals age-eligible for varicella zoster vaccination registered at a general practice in England contributing data to CPRD.Main outcome measuresElectronic health records indicating immunosuppression, zoster vaccination, diagnoses of specific varicella-zoster virus (VZV)-related disease and non-specific rash/encephalitis compatible with VZV-related disease.ResultsBetween 1 September 2013 and 31 August 2017, a period of immunosuppression was identified for 9093/168 767 (5.4%; 95% CI: 5.3%–5.5%) individuals age-eligible for zoster vaccination. The overall rate of vaccination while immunosuppressed was 1742/5251 (33.2 per 100 adjusted person years at risk; 95% CI: 31.9%–34.5%). Follow-up of the 1742 individuals who were inadvertently vaccinated while immunosuppressed identified only two cases of VZV-related disease within 8 weeks of vaccination (0.1%; 95% CI: 0.01%–0.4%), both primary care diagnoses of ‘shingles’, neither with a related hospital admission.ConclusionsDespite evidence of inadvertent vaccination of immunosuppressed individuals with live zoster vaccination, there is a lack of evidence of severe consequences including hospitalisation. This should reassure primary care staff and encourage vaccination of mildly immunosuppressed individuals who do not meet current thresholds for contraindication. These findings support a review of the extent to which live zoster vaccination is contraindicated among the immunosuppressed.

scholarly journals Diagnostic accuracy of follow‐up tests for detecting colorectal cancer recurrences in primary care: A systematic review and meta‐analysis

2021 ◽  
Author(s):  
Geertje B. Liemburg ◽  
Daan Brandenbarg ◽  
Marjolein Y. Berger ◽  
Saskia F.A. Duijts ◽  
Gea A. Holtman ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Primary Care ◽  
Diagnostic Accuracy ◽  
Meta Analysis

scholarly journals Determining the minimal important differences in the International Prostate Symptom Score and Overactive Bladder Questionnaire: results from an observational cohort study in Dutch primary care

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032795 ◽  
Author(s):  
Marco H Blanker ◽  
Harma Johanna Alma ◽  
Tahira Sakina Devji ◽  
Marjan Roelofs ◽  
Martijn G Steffens ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Overactive Bladder ◽  
Symptom Score ◽  
International Prostate Symptom Score ◽  
Short Form ◽  
Minimal Important Difference ◽  
Observational Cohort Study ◽  
Observational Cohort

ObjectivesTo determine the minimal important difference (MID) of the International Prostate Symptom Score (IPSS) and the Overactive Bladder Questionnaire short form (OAB-q SF) assessed in primary care among patients treated for lower urinary tract symptoms (LUTS).DesignSingle-arm, open-label observational cohort study with a 6-week follow-up.SettingTwenty-two pharmacies in the Netherlands.ParticipantsWe enrolled Dutch men with uncomplicated LUTS who received a new alpha-blocker prescription from their general practitioner or urologist.Primary and secondary outcomesThe IPSS and OAB-q SF were completed before and after 6 weeks of therapy. At 6 weeks, men also completed the Patient Global Impression of Improvement (PGI-I). The mean change scores of the IPSS and OAB-q SF were calculated for each PGI-I outcome category, with the category ‘a little better’ used to determine the MID. The SE of measurement (SEM) was calculated for each questionnaire.ResultsIn total, 165 men completed follow-up. The MID was 5.2 points (95% CI 3.9 to 6.4; SEM 3.6) for the IPSS and 11.0 points (95% CI 7.1 to 14.9; SEM 9.7) for the OAB-q SF. For both questionnaires, CIs showed an overlap with the no-change categories. However, the MID for the IPSS was higher in men with severe baseline symptoms (7.1; 95% CI 5.3 to 9.0) than in men with moderate baseline symptoms (3.2; 95% CI 1.7 to 4.8).ConclusionIn this study, the MID for the IPSS was considerably higher than the MID of 3.1 reported in the only other study on this topic, but may be due to methodological differences. Interpretation of the MID for the OAB-q SF is hampered by the overlap with the SEM. Future studies are needed to confirm our results because correlations between the PGI-I and symptom questionnaires were suboptimal.

scholarly journals Clinical effectiveness of online computerised cognitive–behavioural therapy without support for depression in primary care: randomised trial

2009 ◽  
Vol 195 (1) ◽  
pp. 73-80 ◽  
Author(s):  
L. E. de Graaf ◽  
S. A. H. Gerhards ◽  
A. Arntz ◽  
H. Riper ◽  
J. F. M. Metsemakers ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Behavioural Therapy ◽  
Randomised Trial ◽  
Severe Depression ◽  
Clinical Effectiveness ◽  
Behavioural Therapy ◽  
Treatment As Usual ◽  
Intention To Treat ◽  
Cognitive Behavioural

BackgroundComputerised cognitive–behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression.AimsTo determine the clinical effectiveness of online, unsupported CCBT for depression in primary care.MethodThree hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period.ResultsNo significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses.ConclusionsOnline, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depression.

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