These 2 biases are both likely to exaggerate the chronicity of depression. This approach avoids the “clinician's illusion,” 2 sometimes called Neyman bias. For this reason, the natural history of depressive disorder is best studied through prospective follow-up of a sample of individuals experiencing first lifetime onsets-that is, from the first episode forward. 1 Many individuals with a depressive episode do not experience a recurrence, and those who do represent the more chronic and severe cases. This sample source avoids the Berkson bias. For this reason, the natural history of depressive disorder is best studied using a population-based sample, in which individuals are selected from the general population without regard to treatment. Many individuals with depressive disorder do not seek treatment, and those who do presumably represent the most severe cases. About half of those with a first-onset episode recover and have no furtherepisodes. There were few strong predictors of recovery or recurrence.Ĭonclusions Major depressive disorder is unremitting in 15% of cases and recurrent in 35%. Individuals with 1 or 2 short alleles of the serotonin transporter gene were at higher risk for an initial episode, but experienced episodes of shorter duration. The evolution of the course was relatively stable from first to later episodes. About 50% of first episode participants recovered and had no future episodes. #DEPRESSIVE EPISODE FREE#About 15% of 92 individuals with first episodes did not have a year free of episodes, even after 23 years. Results Female participants showed higher risk of onset of disorder, longer duration of episodes, and a nonsignificant tendency for higher risk of recurrence. Outcome Measures Diagnostic Interview Schedule and Life Chart Interview. Participants Probability sample of 3481 adult household residents in 1981, including 92 with first lifetime onset of major depressive disorder during the course of the follow-up, and 1739 other participants followed up for at least 13 years. Setting East Baltimore, Maryland, an urban setting. Objectives To estimate risk factors for first lifetime onset and parameters of chronicity following the first episode, including duration, recovery, and recurrence, and to search for predictors of each parameter.ĭesign Prospective population-based cohort study with 23 years of follow-up.
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