Potential predictors of delay in initial treatment contact after the first onset of depression in Japan: a clinical sample study.

Yoshiyo Oguchi,Mitsunori Hiyama,Masaru Mimura,Mitsuhiro Sado,Sayuri Takechi,Dai Mitsuda,Atsuo Nakagawa,Yuko Nakagawa,Noriko Kato

doi:10.1186/1752-4458-8-50

Abstract

BackgroundA growing body of evidence shows that reducing the duration of untreated illness (DUI) correlates with improved clinical outcome and course of depression. However, the factors involved in delaying treatment contact after the first onset of lifetime depression are not fully understood. This cross-sectional study aims to identify the characteristics that may predict the delay in initial treatment contact after the first onset of lifetime depression by comparing the socio-demographics and clinical characteristics between those with longer and shorter DUI in a well-characterized Japanese clinical sample.MethodsNinety-five patients with depression with longer (>12 months) and shorter DUI (≤12 months) at three Japanese outpatient clinics were studied. Subjects received a comprehensive evaluation, including semi-structured clinical interviews and assessment battery, and their clinical charts were reviewed.ResultsOf the total sample, the median of DUI was 4 months (interquartile range (IQR) 25th–75th percentile, 2–13). We found that 72.6% of patients seek treatment contact within the first year of depression onset. Multivariate logistic regression analysis showed that longer DUI in patients was associated with marital status (never married). Further, the DSM-IV melancholic features approached significance.ConclusionsOur findings suggest that most Japanese patients with depression are likely to seek treatment within 1 year of onset, and that marital status and melancholia may be potential predictors of the delay in the initial treatment contact after the first onset of lifetime depression.

Highlights

A growing body of evidence shows that reducing the duration of untreated illness (DUI) correlates with improved clinical outcome and course of depression
We aimed to identify the characteristics that associate with the delay in the initial treatment contact after the first onset of lifetime depression by assessing the DUI and comparing the socio-demographics and clinical characteristics in a well-characterized Japanese clinical sample
All patients provided written informed consent for being interviewed and for having the clinical information in their charts reviewed, as approved by the Ethical Committee of Keio University School of Medicine, National Hospital Organization Tokyo Medical Center, and Sakuragaoka Memorial Hospital. Those patients who had a Diagnostic and statistical manual of mental disorders (DSM-IV) diagnosis (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) of major depressive disorder based on the Structured Clinical Interview for DSM-IV (SCID) [26], were included

Summary

Introduction

A growing body of evidence shows that reducing the duration of untreated illness (DUI) correlates with improved clinical outcome and course of depression. Major depression is a common medical disorder associated with marked functional impairment [1,2], and is recognized as one of the leading causes of disability in a population [3] This has a significant impact on individuals and society, and is predicted to be the second largest contributor to the global disease burden by 2020 among high-income countries [4]. There is a growing body of evidence showing that reducing the duration of untreated illness (DUI), defined as the interval between the onset of a patient’s first psychiatric episode and the beginning of the first appropriate treatment [14], correlates with improved clinical outcome and the course of various mental disorders such as schizophrenia [15], bipolar disorder [16], unipolar depression [17], panic disorder [18], generalized anxiety disorder [19], and obsessivecompulsive disorder [20]. Reducing the interval between the onset of depression and the start of appropriate treatment might improve the evolution of the depression, and even prevent progression to other medical problems

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