CHARACTERISTICS AND SIGNIFICANCE OF UNTREATED MAJOR DEPRESSIVE DISORDER

Objective: This study sought to describe the characteristics and conse quences of untreated major depressive disorder. Method: As part of a f amily study of probands with major affective disorders, raters assesse d 3,119 first-degree relatives, spouses, and comparison subjects. When 2,237 (71.7%) of these individuals were reassessed 6 years later, 547 had experienced episodes of major depressive disorder in the interval . Those who had sought any form of treatment for any episode of major depressive disorder in the interval were compared, by baseline demogra phic characteristics and clinical features of their worst episodes of major depressive disorder, to those who had not. Individuals who had h ad untreated major depressive disorder were then compared, by changes in socioeconomic status and by levels of psychosocial impairment at fo llow-up, to a matched group with no major depressive disorder in the i nterval. Results: The worst episodes of 313 treated individuals, compa red to those of 234 untreated individuals, were characterized by older age, symptoms of the endogenous subtype, longer durations, and the pr esence of disruption in role function. Each of these factors contribut ed independently to she distinction between treated and untreated epis odes. Untreated individuals experienced significant psychosocial impai rment on follow-up but did not show the economic disadvantages shown e lsewhere for probands who began follow-up as they sought treatment at tertiary medical centers. Conclusions: These data suggest that illness characteristics and age determine the decision to seek treatment for major depressive disorder. Untreated depression is apparently associat ed with long-standing psychosocial difficulties but not with serious e conomic consequences.