Can one predict the long-term outcome of hospitalized depressives?

This paper summarizes the methodological aspects and findings of a long-term study involving 89 depressed patients who were admitted to the Royal Maudsley Hospital between 1965 and 1966, and who were followed- up 18 years later. Less than 20% of the survivors had remained well and > 33% of the series suffered unnatural death or severe chronic distress and handicap. Patients whose index episode marked their first psychiatric contact had a 50% chance of readmission within their lifetime, but those with previous admissions had a 50% chance of readmission within 3 years. High neuroticism scores on the Eysenck Personality Inventory on recovery, and when ill but referring to the pre-morbid state, were associated with poor overall outcome and chronicity. High obsessional interference scores on the Leyton Obsessional Inventory on recovery were also associated with poor long-term outcome, impaired social adjustment, more time spent in hospital and with the subsequent development of schizophrenic or schizoaffective episodes. Subtyping according to the Research Diagnostic Criteria, DSM-III, Newcastle Index and PSE/Catego criteria had little prognostic utility. However, DSM-III melancholia was shown to have an interactive effect with the personality measure neuroticism such that melancholic individuals, who at index had high neuroticism scores, were very likely to have a poor outcome.