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Am J Psychiatry 1992; 149:93-99
Copyright © 1992 by American Psychiatric Association
Recovery and major depression: factors associated with twelve-month outcome
GI Keitner, CE Ryan, IW Miller and WH Norman
Department of Psychiatry and Human Behavior, Brown University, Providence, RI.
OBJECTIVE: In spite of the prevalence and chronicity of major depression,
there is no consensus regarding which clinical and psychosocial variables
are associated with recovery. The authors examined the probability of
recovery from a major depressive episode 12 months after hospital
discharge, the factors most closely associated with recovery, and the
patterns of improvement distinguishing patients who recovered from those
who did not. METHOD: Seventy-eight inpatients with a DSM-III diagnosis of
major depression were assessed at hospitalization and at monthly intervals
for 12 months after discharge on a variety of clinical and psychosocial
factors. Recovery status at 12-month follow-up was then used as a basis for
comparing acute-phase patient characteristics and change in symptoms over
time. RESULTS: By the 12th month of follow-up, 34 (48.6%) of 70 patients
met criteria for recovery. The five most important factors related to
recovery were shorter length of hospital stay, older age at onset of
depression, better family functioning, fewer than two previous
hospitalizations, and absence of comorbid illness. The majority of patients
who had recovered by 12 months had done so within 6 months of discharge;
the average length of time to recovery was 4.9 months. CONCLUSIONS:
Patients hospitalized for major depression have less than a 50-50 chance of
recovering by 1 year. Some variables associated with nonrecovery (e.g.,
comorbid illness, poor family functioning) are amenable to clinical
intervention; however, findings also suggest that there may be two distinct
types of depressive illness with respect to recovery, one that remits
quickly and the other with a more prolonged course of illness.
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