In 1987, a multicentric research was carried out in Emilia-Romagna, an adminis trative area in northern Italy. Nine hundred and forty one people in the general medical sector were contacted to enter a two-stage procedure to identify DSM-III cases. Cases were recontacted for 3-month, 1-year and 2-year follow-ups.
Eighty cases completing at least the one-year follow-up were analysed. The sample was split into "still-cases" and "no longer-cases" depending on the persistence of a DSM-III diagnosis at the last follow-up.
Both clinical and social features proved to be predictors of the outcome. A disorder lasting one year or longer, past recurrences, Axis I comorbidity, older age, being married and having children were the features which at the first assessment predicted an unfavourable outcome. Having children and past episodes proved to be the best predictors of remaining a case in a stratified logistic regression model.
The persistence of major difficulties during the follow-up period was also correlated to a "still-case" status.
Get full access to this article
View all access options for this article.
References
1.
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd Edition). Washington D.C.: A.P.A.
2.
Bech, P., Kastrup, M. & Rafaelsen, O.J. (1986) Mini compendium of rating scales of anxiety, depression, mania, schizophrenia with corresponding DSM-III syndromes. Acta Psychiatrica Scandinavica, Suppl 326, 73, 1-37.
3.
Berti Ceroni, F., Gherardi, S. & Pezzoli, A. (1990) Le variabili extracliniche in disturbi psichici nella medicina di base ed ospedaliera. Rivista di Psichiatria , 25, 111-118.
4.
Berti Ceroni, G., Berti Ceroni, F., Bivi, R., Corsino, M.A., De Marco, P., Gallo, E., Giovannini, G., Gherardi, S., Pezzoli, A., Rucci, P. & Neri, C. (1992) DSM-III mental disorders in general medical sector: a follow-up and incidence study over a two-year period. Social Psychiatry and Psychiatric Epidemiology, 27, 234-241.
5.
Berti Ceroni, G., Neri, C. & Pezzoli, A. (1984) Chronicity in major depression: a naturalistic prospective study. Journal of Affective Disorders, 7, 123-132.
6.
Blacker, C.V.R. & Clare, A.W. (1987) Depressive disorder in primary care. British Journal of Psychiatry, 150, 737-751.
7.
Brown, G.W., Adler, Z. & Bifulco, A. (1988) Life events, difficulties and recovery from chronic depression. British Journal of Psychiatry, 152, 487-498.
8.
Brown, G.W. & Harris, T. (1978) Social Origins of Depression: A Study of Psychiatric Disorder in Women. London; Tavistock .
9.
Catalan, J., Gath, D., Bond, A. & Martin, P. (1984) The effects of non prescribing anxiolytics in general practice. British Journal of Psychiatry, 144, 603-610.
10.
Chamberlain, C., Barnes, S., Waring, E.M., Wood, G. & Fry, R. (1989) The role of marital intimacy in psychiatric help-seeking . Canadian Journal of Psychiatry, 34, 3-7.
11.
Cooper, B. (1965) A study of 100 chronic psychiatric patients identified in general practice. British Journal of Psychiatry, 111, 595-605.
12.
Dew, M.A., Dunn, L.O., Bromet, E.J. & Schulberg, H.C. (1988) Factors affecting help-seeking during depression in a community sample. Journal of Affective Disorders, 14, 223-234.
13.
Eisemann, M. (1984) The availability of confiding persons for depressed patients. Acta Psychiatrica Scandinavica, 70, 166-169.
14.
George, L.K., Blazer, D.G., Hughes, D.C. & Fowler, N. (1989) Social support and the outcome of major depression . British Journal of Psychiatry, 154, 478-485.
15.
Goldberg, D., Bridges, K., Cook, D., Evans, B. & Grayson, D. (1990) The influence of social factors on common mental disorders: destabilisation and restitution. British Journal of Psychiatry, 156, 704-713.
16.
Goldberg, D. & Huxley, P. (1992) Common Mental Disorders: A Bio-social Model. London & New York: Tavistock /Routledge.
17.
Howland, R.H. (1993) Chronic depression. Hospital and Community Psychiatry, 44, 633-639.
18.
Huxley, P.J., Raval, H., Korer, J. & Jacob, C. (1989) Psychiatric morbidity in the clients of social workers: clinical outcome. Psychological Medicine, 19, 189-198.
19.
Johnston, A. & Shepley, M. (1986) The outcome of hidden neurotic illness treated in general practice. Journal of the Royal College of General Practitioners, 36, 413-415.
20.
Kedward, H.B. (1969) The outcome of neurotic illness in the community . Social Psychiatry and Psychiatric Epidemiology, 4, 1-4.
21.
Keller, M.B. & Shapiro, R.W. (1982) "Double depression": superimposition of acute depressive episodes on chronic depressive disorders. American Journal of Psychiatry,139, 438-442.
22.
Keller, M.B., Shapiro, R.W., Lavori, P.W. & Wolfe, N. (1982) Recovery in major depressive disorder. Archives of General Psychiatry,39, 905-910.
23.
Kellner, R. (1987) A symptom questionnaire. Journal ofClinical Psychiatry, 48, 268-274.
24.
Mann, A.H., Jenkins, R. & Belsey, E. (1981) The twelve-month outcome of patients with neurotic illness in general practice. Psychological Medicine, 11, 535-550.
Oatley, K. & Perring, C. (1991) A longitudinal study of psychological and social factors affecting recovery from psychiatric breakdowns. British Journal of Psychiatry, 158, 28-32.
27.
Ormel, J., Oldehinkel, T., Brilman, E. & Vanden Brink, W. (1993) Outcome of depression and anxiety in primary care. Archives of General Psychiatry , 50, 759-766.
28.
Parker, G., Holmes, S. & Manicavasagar, V. (1986) Depression in general practice attenders: "caseness", natural history and predictors of outcome . Journal of Affective Disorders, 10, 27-35.
29.
Parker, G., Tennant, C. & Blignault, I. (1985) Predicting improvement in patients with non-endogenous depression. British Journal of Psychiatry, 146, 132-139.
30.
Rey, J.M., Stewart, G.W., Plapp, J.M., Bashir, M.R. & Richards, I.N. (1988) DSM-III Axis IV revisited . American Journal of Psychiatry, 145:3, 286-292.
31.
Rounsaville, B.J., Weissman, M.M. & Prusoff, B.A. (1981) Psychotherapy with depressed outpatients: patient and process variables as predictors of outcome. British Journal of Psychiatry, 138, 67-74.
32.
Tennant, C., Bebbington, P. & Hurry, J. (1981) The short-term outcome of neurotic disorders in the community: the relationship of remission to clinical factors and to "neutralising" life events. British Journal of Psychiatry, 139, 213-220.
33.
Wittchen, H.U. & Essau, C.A. (1990) Assessment of symptoms and psychosocial disabilities in primary care. In Psychological Disorders in General Medical Settings (eds. N. Sartorius, D. Goldberg, G. De Girolamo, J. Costa E Silva, Y. Lecrubier & U. Wittchen). Toronto/ Lewiston, NY/Bern /Göttingen / Stuttgart: Hogrefe & Huber , 111-136.
