SHORT-TERM OUTCOME OF MAJOR DEPRESSION .1. COMORBIDITY AND SEVERITY AT PRESENTATION AS PREDICTORS OF PERSISTENT DISORDER

Objective: To determine whether there is a pattern of clinical charact eristics at presentation that specifically predicts persistent major d epression at 36 weeks follow-up. Method: Sixty-eight consecutive cases with a first episode DSM-III-R diagnosis of major depression were int erviewed with the Schedule for Affective Disorders and Schizophrenia f or School-Age Children-Present Episode version and completed the mood and feelings self-report depression questionnaire (MFQ) at presentatio n and again at 36 weeks. Results: At presentation, 63 (93%) had one or more comorbid psychiatric disorders (median = 3). At 36 weeks, 17 (25 %) cases were recovered; 17 (25%) continued to meet criteria for one o r more psychiatric disorder but not major depression; 34 (50%) still m et criteria for DSM-III-R major depression, of whom 25 (73%) had been persistently depressed and 9 (27%) had recovered and subsequently rela psed. Major depression at follow-up was specifically predicted by the additive effect of three features at presentation, comorbid obsessive- compulsive disorder, higher MFQ score, and being older. Comorbid oppos itional defiant disorder at presentation was a significant predictor o f persistent psychiatric disorder. Individuals with persistent depress ion (n = 25) were more likely to have a longer duration of illness bef ore presentation. Conclusion: Systematic assessment of comorbid psychi atric conditions at initial interview, together with the use, in older subjects, of a self-report questionnaire to determine subjective seve rity, will provide valid clinical information concerning the potential short-term outcome of major depression.