Factors associated with symptomatic improvement and recovery from major depression in primary care patients

This article describes a post-hoc analysis of clinical and psychosocial fac tors and beliefs about health associated with treatment outcome in a sample of depressed primary care patients (N=181) randomly assigned to a standard ized treatment or physician's usual cave (UC). Different factors were found to predict clinical outcomes for treatment modalily [UC sis. interpersonal psychotherapy (IPT) or nortriptyline (NT)] and the type of outcome evaluat ed (i.e., depressive symptoms at 8 months or symptomatic and functional rec overy at 8 months). Factors associated with treatment-specific outcomes are also described. Consistent with prior studies, lower depressive symptom se verity at 8 months reins associated with higher baseline functioning, minim al medical co-morbidity, race, and standardized pharmacologic or psychother apeutic treatment. Additionally, an interaction between treatment modality and health locus of control indicated that individuals perceiving more self -control of their health and who received a standardized treatment experien ced greater depressive symptom reduction at 8 months. Factors associated wi th symptomatic and functional recovery from the depressive episode were als o examined. Patients who received a standardized treatment (IPT or NT) perc eived greater control of their health and lacked a lifetime generalized anx iety disorder or panic disorder mere more likely to recover by month 8 than those who received usual care. While clinical severity and treatment adequ acy play an important role in both symptomatic improvement and foil recover y from a depressive episode, other key factors such as health beliefs and n on-depressive psychopathology also influence recovery. (C) 2000 Elsevier Sc ience Inc.