The Long Term Outcome of General Practice Depression
Tom Burns, Kathryn Lester, Rowena Merritt, Eugene Paykel and Jenny Yiend
This study investigates the longitudinal course and cross-sectional outcome of general practice depression in terms of rates of remission and recovery, relapse and recurrence, social function and disability and treatment for mental health problems. The study is a follow-up of 167 patients originally treated for depression in general practice in the 1980s and studied then by Professor E.S. Paykel and colleagues. It explores which clinical and historical features at presentation, and in the subsequent year, predict long-term outcomes. These data will be compared with published findings from psychiatrically treated samples where findings indicate high recurrence rates and adverse long-term outcome. There is little data on the long term outcome of the predominantly milder depressions treated in general practice and existing studies suggest that prognosis may be better in them. Recent strong recommendations regarding the need for vigorous maintenance medication may not apply to general practice depressives, who comprise the majority in the UK.
Aims and Objectives
The main study questions include:
1) What is longitudinal course and outcome including recurrence, treatment received, social function, current state?
2) What are the predictors of outcome?
3) What role do life events play in triggering the onset of major depressive episodes and is there any evidence for the recently proposed ‘kindling’ (ie sensitization) effect.