Endogenous, Reactive and Neurotic Depression – Diagnostic Stability and Long-Term Outcome

Abstract

Background: No larger long-term study has been conducted of outcomes of patients diagnosed with endogenous, reactive or neurotic depression and using survival methods in the analyses. Sampling and Methods: All patients who had had their first-ever discharge in the period from 1970 to 1994 with a diagnosis of endogenous, reactive or neurotic depression according to ICD-8 were identified in a nationwide register of admissions to psychiatric wards. Patients were followed up to 1999 and the long-term diagnostic stability, the risk of relapse leading to readmission and the risk of suicide was analysed in the three groups. Results: The diagnostic stability over time of the diagnosis of reactive depression and neurotic depression was low. Patients with neurotic depression had a substantially greater risk of relapse leading to readmission compared to patients with endogenous depression, and patients with reactive depression had less risk of relapse. No differences were found in the risk of completed suicide between the three groups of patients during long-term follow-up. Conclusions: The study does not provide evidence for re-establishing prior diagnostic systems of depressive disorders based on the presence or absence of neurotic characteristics or on the presence or absence of a psychic trauma as in ICD-8.