Abstract
This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care. We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted. Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3-4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3-4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions. When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.
Highlights
Depression is a burdensome disease with a high prevalence, affecting one in 20 adults at any one time (Thornicroft et al, 2017)
The CIS-R is a measure commonly used in randomised controlled trials (RCTs) and epidemiological studies that has been translated into many languages (McManus, Bebbington, Jenkins, & Brugha, 2016; Subramaniam, Krishnaswamy, Jemain, Hamid, & Patel, 2006)
A key question in this study was whether or not adjusting for depressive symptom severity ameliorates the associations between depressive ‘disorder characteristics’ and prognosis independent of treatment, descriptive statistics are presented stratified by a median split of depressive symptom severity (Table 2)
Summary
Depression is a burdensome disease with a high prevalence, affecting one in 20 adults at any one time (Thornicroft et al, 2017). At the outset of treatment, it is impossible to know what future treatments a patient will receive so general information about prognosis, that would apply to all treatments, is of clinical value (Hippisley-Cox et al, 2007; Trusheim et al, 2007); this can be called ‘prognosis independent of treatment’ Another approach to studying prognostic factors is to identify people with depression from cohort studies. When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression
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