Autonomy is a key factor in the reduction of inequitable physical healthcare among people with severe mental illness compared with the general population.

To clarify the critical mechanism underlying autonomy in physical health promotion based on the perspectives of people with severe mental illness.

We employed a conventional content analysis of narrative data from the Healthy Active Lives in Japan (HeAL Japan) workshop meetings.

‘Inhibited autonomy’ was extracted as a central component and shaped by the users’ experiences, both in a healthcare setting and in real life. This component emerged based on the lack of an empowerment mechanism in psychiatric services.

A barrier to the encouragement of autonomy in physical health promotion was found in current psychiatric services. An effective strategy should be explored to foster an empowerment mechanism in psychiatric and mental health services.

None.

Generalisability of existing studies on the naturalistic history of major depression is undermined by overrepresentation of in-patients and tertiary care academic centres, inclusion of patients already on treatment and/or incomplete follow-up.

To report the time to recovery of an inception cohort of unipolar major depressive episodes.

A multi-centre prospective follow-up study of patients with a mood disorder, who had been selected to be representative of the untreated first-visit patients at 23 psychiatric settings from all over Japan.

The median time to recovery of the index episode after treatment commencement was 3 months (95% CI 2.5–3.6): 26% of the cohort reached asymptomatic or minimally symptomatic status by I month, 63% by 3 months, 85% by 12 months and 88% by 24 months.

Our estimate of the episode length was 25–50% shorter than estimates reported in the literature.