Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
J Psychiatr Res. 2019 Jul;114:80-87. doi: 10.1016/j.jpsychires.2019.04.015. Epub 2019 Apr 19.
Specific predictors of relapse/recurrence in major depressive disorder (MDD) have been identified but evidence across studies are inconsistent. This study aimed to identify the most relevant socio-demographic/clinical predictors of MDD recurrence in a sample of 508 outpatients.
This naturalistic cohort study included 508 currently euthymic MDD patients (mean age = 54.1 ± 16.2) of which 53.9% had a single and 46.1% recurrent depressive episodes. A detailed data collection was performed and illness histories were retraced through clinical files and lifetime computerized medical records.
Compared to patients with single episode, MDD patients with recurrent episodes significantly differ regarding current age, gender, working status, positive history of psychiatric disorders in family, first-lifetime illness episode characteristics, first-episode and current psychotic symptoms, current melancholic features and seasonality, age at first treatment, duration of untreated illness, and comorbid cardiovascular/endocrinological conditions. However, after multivariate analyses controlling for current age, gender, educational level, working status differences, psychiatric conditions in family, and age of illness episode, recurrence was associated with older age (p ≤ .001), younger age at first treatment (p ≤ .005), being treated with previous psychoactive treatments (p .001), and longer duration of untreated illness (p .001).
The variables associated with MDD recurrence identified in the current study may aid in the stratification of patients who could benefit from more intensive maintenance treatments for MDD. However, clinicians should rapidly identify cases that are not likely to recur in order to avoid unnecessary treatments which are commonly considered as the standard of care.
重度抑郁症（MDD）复发/再发的具体预测因素已被确定，但各研究间的证据并不一致。本研究旨在 508 例门诊患者中确定 MDD 复发的最相关社会人口学/临床预测因素。
这是一项自然队列研究，纳入了 508 例目前处于缓解期的 MDD 患者（平均年龄 54.1±16.2），其中 53.9%为单次发作，46.1%为复发性抑郁发作。通过临床档案和终身计算机病历详细收集数据并追溯病史。
与单次发作患者相比，复发性 MDD 患者在当前年龄、性别、工作状况、家族中有精神病史、首次发作疾病特征、首次发作和当前精神病性症状、当前忧郁特征和季节性、首次治疗年龄、未治疗疾病持续时间以及合并心血管/内分泌疾病方面存在显著差异。然而，在调整当前年龄、性别、教育程度、工作状况差异、家族精神病史和发病年龄后，多变量分析显示复发与年龄较大（p≤.001）、首次治疗年龄较小（p≤.005）、以前接受过精神活性治疗（p.001）和未治疗疾病持续时间较长（p.001）相关。
本研究确定的与 MDD 复发相关的变量可能有助于对需要更强化 MDD 维持治疗的患者进行分层。然而，临床医生应迅速识别不太可能复发的病例，以避免不必要的治疗，这些治疗通常被认为是标准护理。
