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Recurrence of major depressive disorder and its predictors in the general population: results from The Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Published online by Cambridge University Press:  31 October 2012

F. Hardeveld*
Affiliation:
Pro Persona, Institute for Mental Health Care, Ede, The Netherlands Netherlands Institute of Mental Health and Addiction, The Netherlands
J. Spijker
Affiliation:
Pro Persona, Institute for Mental Health Care, Ede, The Netherlands Netherlands Institute of Mental Health and Addiction, The Netherlands
R. De Graaf
Affiliation:
Netherlands Institute of Mental Health and Addiction, The Netherlands
W. A. Nolen
Affiliation:
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
A. T. F. Beekman
Affiliation:
Department of Psychiatry and Institute for Research in Extramural Medicine, VU University Medical Center Amsterdam, The Netherlands
*
*Address for correspondence: F. Hardeveld, Pro Persona, PO Box 70, 6710 RR, Ede, The Netherlands. (Email: f.hardeveld@propersona.nl)

Abstract

Background

Knowledge of the risk of recurrence after recovery from major depressive disorder (MDD) in the general population is scarce.

Method

Data were derived from 687 subjects in the general population with a lifetime DSM-III-R diagnosis of MDD but without a current major depressive episode (MDE) or dysthymia. Participants had to be at least 6 months in remission, and were recruited from The Netherlands Mental Health Survey and Incidence Study (NEMESIS), using the Composite International Diagnostic Interview (CIDI). Recency and severity of the last MDE were assessed retrospectively at baseline. Recurrence of MDD was measured prospectively during the 3-year follow-up. Kaplan–Meier survival curves were used to measure time to recurrence. Determinants of time to recurrence were analyzed using proportional hazard models.

Results

The estimated cumulative recurrence of MDD was 13.2% at 5 years, 23.2% at 10 years and 42.0% at 20 years. In bivariate analysis, the following variables predicted a shorter time to recurrence: younger age, younger age of onset, higher number of previous episodes, a severe last depressive episode, negative youth experiences, ongoing difficulties before recurrence and high neuroticism. Multivariably, younger age, a higher number of previous episodes, a severe last depressive episode, negative youth experiences and ongoing difficulties remained significant.

Conclusions

In this community sample, the long-term risk of recurrence was high, but lower than that found in clinical samples. Subjects who had had an MDE had a long-term vulnerability for recurrence. Factors predicting recurrence included illness- and stress-related factors.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2012

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