Abstract
ObjectiveTo investigate associations between major life events and prognosis independent of treatment type: (1) after adjusting for clinical prognostic factors and socio-demographics; (2) amongst patients with depressive episodes at least six-months long; and (3) patients with a first life-time depressive episode. MethodsSix RCTs of adults seeking treatment for depression in primary care met eligibility criteria, individual patient data (IPD) were collated from all six (n = 2858). Participants were randomized to any treatment and completed the same baseline assessment of life events, demographics and clinical prognostic factors. Two-stage random effects meta-analyses were conducted. ResultsReporting any major life events was associated with poorer prognosis regardless of treatment type. Controlling for baseline clinical factors, socio-demographics and social support resulted in minimal residual evidence of associations between life events and treatment prognosis. However, removing factors that might mediate the relationships between life events and outcomes reporting: arguments/disputes, problem debt, violent crime, losing one's job, and three or more life events were associated with considerably worse prognoses (percentage difference in 3–4 months depressive symptoms compared to no reported life events =30.3%(95%CI: 18.4–43.3)). ConclusionsAssessing for clinical prognostic factors, social support, and socio-demographics is likely to be more informative for prognosis than assessing self-reported recent major life events. However, clinicians might find it useful to ask about such events, and if they are still affecting the patient, consider interventions to tackle problems related to those events (e.g. employment support, mediation, or debt advice). Further investigations of the efficacy of such interventions will be important.
Highlights
Stressful major life events, such as losing one’s job, problematic debt, or divorce, are common (Costello, 1982; McCraw and Parker, 2017; McLaughlin et al, 2010)
In an earlier study (Buckman et al, 2021a), we reviewed systematic reviews that reported on associations between patient characteristics and prognosis for adults with depression, in relation to both the natural course of depression for those not treated, and treatment outcomes for those that received any treatment for depression
Based on the GRADE framework, we considered the quality of evidence for life events as a prognostic indicator to be high; interrater reliability was very high across both measures: Cohen’s Kappa k = 0.98 for Quality in Prognosis Studies (QUIPS) and k = 1.00 for GRADE
Summary
Stressful major life events, such as losing one’s job, problematic debt, or divorce, are common (Costello, 1982; McCraw and Parker, 2017; McLaughlin et al, 2010). The COVID-19 pandemic and related governmental responses are thought to have resulted in an increase in people experiencing many kinds of major life events, such as serious illness (WHO, 2020; Xiao and Torok, 2020), bereavement (Gunnell et al, 2020), losing one’s job, and grave financial problems (Gangopadhyaya and Garrett, 2020; Gunnell et al, 2020; Holmes et al, 2020; Xiao and Torok, 2020) They have been reported to have led to greater exposure of some populations to assault, or other forms of violence (Gunnell et al, 2020; Hall et al, 2020; Takian et al, 2020). As treatment outcomes are a strong indicator of the risk of future episodes in general (Buckman et al, 2018; Fava et al, 2004), and the plan of treatment for first onset cases is typically quite different from those with a history of recurrences (for whom there is a trend towards indefinite treatment with antidepressants; (Thase, 2006)), advancing knowledge about any prognostic association between major life events and depression treatment outcomes may be particu larly valuable
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