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  • Title: Onset of remission and relapse in depression: testing operational criteria through course description in a second Dublin cohort of first-admission participants.
    Author: O'Leary D, Hickey T, Lagendijk M, Webb M.
    Journal: J Affect Disord; 2010 Sep; 125(1-3):221-6. PubMed ID: 20303600.
    Abstract:
    BACKGROUND: This paper extends previous work describing course in depression using a recommended operational model that defines remission onset and relapse. We test whether a similar course pattern would emerge using this model in a new cohort of depressed participants. METHODS: We recruited a cohort of 86 participants, first-time inpatients, with DSM-IV major depression. Outcome was assessed prospectively over a 13-month minimum follow-up period. Remission onset was defined as a Ham-D score <8 for two consecutive weeks; relapse as a Ham-D score >16 for two consecutive weeks and meeting DSM-IV criteria for major depressive disorder. RESULTS: The cumulative probability of remission onset was 0.62 (SE=0.05) and 0.80 (SE=0.05) at 3 and 6 months following study entry. The relapse risk was 0.28 (SE=0.05) at 6 months post remission onset; 53% of those relapsing did so in the first 2 months post remission onset. Predictors of longer times to remission onset included: longer illness length, higher anxiety scores and unemployment; higher anxiety scores predicted relapse. The course pattern is similar to that reported previously. LIMITATIONS: These findings apply to inpatients only. Course was not rated blind to all of the participants' baseline data. CONCLUSIONS: Defining remission onset and relapse using this model is associated with a replicable course pattern. A singular clinical advantage of the model is the identification of those participants at highest risk of relapse 2 months post remission onset.
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