Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands.
Acta Psychiatr Scand. 2018 Jun;137(6):503-515. doi: 10.1111/acps.12874. Epub 2018 Mar 25.
The naturalistic course of major depressive disorder (MDD) and risk indicators for recurrence and chronicity are best studied using a population sample without clear selection bias. However, such studies are scarce. This limits clinical decision-making concerning monitoring and maintenance treatment.
Data were used from the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among a representative adult population. Two groups at baseline were selected to study recurrence and chronicity of MDD at follow-up. Diagnoses were assessed with the Composite International Diagnostic Interview 3.0.
Among remitted MDD cases (n = 746), the cumulative recurrence rate was 4.3% at 5 years, 13.4% at 10 years and 27.1% at 20 years. Time to recurrence was predicted by vulnerability characteristics (childhood abuse, negative life events, parental psychopathology), physical health, functioning, clinical characteristics of depression (previous episodes, severity, medication use), psychiatric comorbidity and mental health use. Among current MDD cases (n = 242), 12% developed a chronic depressive episode over 6 years. Chronic course was predicted by similar risk indicators as recurrence, except for vulnerability characteristics and physical health.
These risk indicators may help to identify patients requiring monitoring and who could benefit from preventive interventions or maintenance treatment.
重度抑郁症（MDD）的自然病程以及复发和慢性的风险指标最好在没有明显选择偏差的人群样本中进行研究。然而，这样的研究很少。这限制了关于监测和维持治疗的临床决策。
本研究使用了荷兰精神健康调查和发病率研究-2 的数据，这是一项针对代表性成年人群的精神流行病学队列研究。在基线时选择了两组来研究 MDD 在随访中的复发和慢性。使用复合国际诊断访谈 3.0 进行诊断评估。
在缓解的 MDD 病例（n=746）中，5 年内的累积复发率为 4.3%，10 年内为 13.4%，20 年内为 27.1%。复发的时间由易感性特征（儿童期虐待、负面生活事件、父母精神病理学）、身体健康、功能、抑郁的临床特征（既往发作、严重程度、药物使用）、精神共病和心理健康使用来预测。在当前 MDD 病例（n=242）中，12%的人在 6 年内发展为慢性抑郁发作。慢性病程由类似的风险指标预测，除了易感性特征和身体健康。
这些风险指标可能有助于识别需要监测的患者，以及那些可能受益于预防干预或维持治疗的患者。
