Seeing the signs: Using the course of residual depressive symptomatology to predict patterns of relapse and recurrence of major depressive disorder

Floor E. A. Verhoeven, Klaas J. Wardenaar, Henricus G. Eric Ruhé, Henk Jan Conradi, Peter de Jonge

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19 Citations (Scopus)
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Abstract

BACKGROUND: Major depressive disorder (MDD) is characterized by high relapse/recurrence rates. Predicting individual patients' relapse/recurrence risk has proven hard, possibly due to course heterogeneity among patients. This study aimed to (1) identify homogeneous data-driven subgroups with different patterns of relapse/recurrence and (2) identify associated predictors.

METHODS: For a year, we collected weekly depressive symptom ratings in 213 primary care MDD patients. Latent class growth analyses (LCGA), based on symptom-severity during the 24 weeks after no longer fulfilling criteria for the initial major depressive episode (MDE), were used to identify groups with different patterns of relapse/recurrence. Associations of baseline predictors with these groups were investigated, as were the groups' associations with 3- and 11-year follow-up depression outcomes.

RESULTS: LCGA showed that heterogeneity in relapse/recurrence after no longer fulfilling criteria for the initial MDE was best described by four classes: "quick symptom decline" (14.0%), "slow symptom decline" (23.3%), "steady residual symptoms" (38.7%), and "high residual symptoms" (24.1%). The latter two classes showed lower self-esteem at baseline, and more recurrences and higher severity at 3-year follow-up than the first two classes. Moreover, the high residual symptom class scored higher on neuroticism and lower on extraversion and self-esteem at baseline. Interestingly, the steady residual symptoms and high residual symptoms classes still showed higher severity of depressive symptoms after 11 years.

CONCLUSION: Some measures were associated with specific patterns of relapse/recurrence. Moreover, the data-driven relapse/recurrence groups were predictive of long-term outcomes, suggesting that patterns of residual symptoms could be of prognostic value in clinical practice.

Original languageEnglish
Pages (from-to)148-159
Number of pages12
JournalDepression and Anxiety
Volume35
Issue number2
Early online date11-Dec-2017
DOIs
Publication statusPublished - Feb-2018

Keywords

  • Journal Article
  • PRIMARY-CARE PATIENTS
  • COGNITIVE-BEHAVIORAL THERAPY
  • COURSE TRAJECTORIES
  • RISK-FACTORS
  • FOLLOW-UP
  • SYMPTOMS
  • RESILIENCE
  • RECOVERY
  • ANXIETY
  • POPULATION

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