The importance of the first three days: predictors of treatment outcome in depressed in-patients.

This study investigated whether initial reactions, as shown by depressed patients and by the psychiatrist in charge within the first three days of complex hospital treatment, predicted outcome. Sixty-three patients with depressive disorders according to ICD-10 were examined. In addition to basic socio-demographic and clinical data and to baseline symptoms, psychiatrists' optimism, patients' global assessment of treatment and symptom change within the first three days were tested as predictors. The outcome criteria were both observer and self-ratings of symptoms at discharge. Psychiatrists' optimism was the best single predictor of each outcome criterion. Patients' initial subjective reactions predicted self-rated symptoms at discharge. In stepwise multiple regression analyses initial reactions contributed significantly and - in two cases - separately to the overall prediction of outcome. Patients' and psychiatrists' initial reactions in complex hospital treatment of depression are relatively good predictors of outcome and should, therefore, be monitored carefully in research and in clinical practice.