CLINICAL AND PSYCHOSOCIAL ORIGINS OF CHRONIC DEPRESSIVE EPISODES .2. A PATIENT INQUIRY

Background. We consider how well the psychosocial and clinical factors found to predict a chronic course for depressive episodes in the comm unity, held for female psychiatric patients. Method. A consecutive ser ies of depressed patients, aged 18 to 60, treated as in-patients, out- patients or day-patients at psychiatric departments of two London hosp itals, were interviewed initially and at follow-up two years later. Re sults. indices of childhood adversity and current interpersonal diffic ulties predicted episodes taking a chronic course (of more than 12 mon ths' duration). Half of the episodes associated with one or the other factor were chronic, compared with 22% of those with neither. The pati ents were at higher risk than the community series (75% v. 34%) and th is explains their much greater rate of chronicity. There was also some evidence that social support reduced risk. Clinical features and the presence of a personality disorder were unrelated to chronicity. Concl usions. Similar psychosocial factors are important for predicting chro nicity in both community and patient series.