10-YEAR FOLLOW-UP OF DEPRESSION AFTER DIAGNOSIS IN GENERAL-PRACTICE

Background. Depression is a serious illness with a high recurrence rat e, mortality, and suicide rate, and a substantial loss of quality of l ife. Long-term course of depression, in particular of patients not ref erred to specialist care, is not completely clear. We performed a stud y in which the course of depression in general practice was studied fo r 10 years after the first diagnosis. Aim. To learn more about long-te rm course and outcome of patients with depressive illness for a full 1 0 years after diagnosis. Method. A historic cohort study with 386 pati ents classified as depressive before January 1984, recruited from four general practices belonging to the Continuous Morbidity Registry of t he University of Nijmegen in The Netherlands. This cohort was followed up for 10 years. Mortality was compared with a control group matched for age, sex, social class, and practice. Of 222 patients out of this cohort who could be followed up for a full 10 years after diagnosis, t he case records were studied in detail. Results. No statistically sign ificant difference was found in mortality between the 386 patients and The control group. Recurrence of depressive episodes did not occur in about 60% of the 222 patients (confidence interval 54% to 67%). Of th e depressive patients, 15% were referred to secondary care and 9% were admitted to hospital. Conclusion. Mortality, suicide, and recurrence rate were lower than expected taking into account what is known from d epression studies in psychiatry. These results stress the importance o f long-term prospective follow-up studies of all patients with depress ion because of the emphasis on case-finding and treatment without exac t knowledge of long-term course and outcome of patients who were not r eferred.