Remission onset and relapse in depression - An 18-month prospective study of course for 100 first admission patients

Background: Few prospective studies of course for first admission depressiv es are reported. Methods: One hundred consecutive depressed inpatients were followed prospectively over 18 months. Course was defined operationally us ing the Hamilton Depression scale and ICD-10 criteria. Results were analyse d using life-tables. Results: The cumulative probabilities of remission ons et by 3 and 18 months were 0.67 (95% C.I. = 0.57-0.77) and 0.82 (95% C.I. = 0.74-0.90). The cumulative probability of relapse was 0.25 (95% C.I. = 0.1 5-0.35); 53% of those relapsing did so in the first 2 months. Younger age a t onset, longer illness length, higher depression and anxiety ratings, pred icted delayed remission onset. ICD-10 episode severity predicted relapse. C onclusions: The chances of remission onset at 3 months and relapse were inc reased relative to other studies; risk of chronicity was similar. Predictor s of outcome to emerge were similar to other studies. Clinical implications : Adoption of these remission onset criteria may identify earlier (at 3 mon ths), subjects at high risk of chronicity. After remission onset, subjects with severe illnesses warrant careful follow-up to detect relapse, particul arly during the first 2 months. Limitations: The operational criteria used were different to other prospective studies. Relatively few psychosocial va riables were included in the analysis. (C) 2000 Elsevier Science B.V. All r ights reserved.