Articlehybrid2006

A major depression prognosis calculator based on episode duration.

45 citations0/0 files storedClinical Practice and Epidemiology in Mental Health

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Mental Health Treatment and Access Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Treatment of Major Depression

Abstract

BACKGROUND: Epidemiological data have shown that the probability of recovery from an episode declines with increasing episode duration, such that the duration of an episode may be an important factor in determining whether treatment is required. The objective of this study is to incorporate episode duration data into a calculator predicting the probability of recovery during a specified interval of time. METHODS: Data from two Canadian epidemiological studies were used, both studies were components of a program undertaken by the Canadian national statistical agency. One component was a cross-sectional psychiatric epidemiological survey (n = 36,984) and the other was a longitudinal study (n = 17,262). RESULTS: A Weibull distribution provided a good description of episode durations reported by subjects with major depression in the cross-sectional survey. This distribution was used to develop a discrete event simulation model for episode duration calibrated using the longitudinal data. The resulting estimates were then incorporated into a predictive calculator. During the early weeks of an episode, recovery probabilities are high. The model predicts that approximately 20% will recover in the first week after diagnostic criteria for major depression are met. However, after six months of illness, recovery during a subsequent week is less than 1%. CONCLUSION: The duration of an episode is relevant to the probability of recovery. This epidemiological feature of depressive disorders can inform prognostic judgments. Watchful waiting may be an appropriate strategy for mild episodes of recent onset, but the risks and benefits of this strategy must be assessed in relation to time since onset of the episode.

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References

2004The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)1998The World Health Organization Composite International Diagnostic Interview short‐form (CIDI‐SF)2002Revised Prevalence Estimates of Mental Disorders in the United States 1999Stepped Collaborative Care for Primary Care Patients With Persistent Symptoms of Depression 2002Duration of major depressive episodes in the general population: Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)2000Randomized Trial of a Depression Management Program in High Utilizers of Medical Care 2005The Canadian Community Health Survey: Mental Health and Well-Being 2001Improving Primary Care for Depression in Late Life: The Design of a Multicenter Randomized Trial

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