Relapse of depression in primary care. Rate and clinical predictors

Arch Fam Med. Sep-Oct 1998;7(5):443-9. doi: 10.1001/archfami.7.5.443.


Objective: To determine the clinical predictors and rate of relapse for major depression in primary care.

Design: A cohort study of subjects in 2 randomized trials of depressed patients diagnosed and prescribed antidepressant medicine by primary care physicians. Baseline, 7-month, and 19-month assessments were conducted.

Setting: A large primary care clinic of a staff-model health maintenance organization.

Patients: Two hundred fifty-one primary care patients who did not satisfy Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for major depression at 7 months.

Main outcome measures: Relapse was defined as (1) satisfying DSM-III-R criteria for major depression at 19 months, or (2) reporting an interval episode of 2 weeks or more of depressed mood and symptoms between 7 and 19 months. Predictors examined included demographic characteristics, medical comorbidity, disability, and psychological symptoms. Depressive symptoms were measured by Inventory of Depressive Symptoms and Hopkins Symptoms Checklist.

Results: Of the patients, 37.1% reported relapse of depression in the 12-month relapse-risk period. The 2 major risk factors associated with relapse were (1) persistence of subthreshold depressive symptoms 7 months after the initiation of antidepressant therapy (odds ratio, 3.3; 95% confidence interval, 2.74-3.93) and (2) history of 2 or more episodes of major depression, or chronic mood symptoms for 2 years (odds ratio, 2.1; 95% confidence interval, 1.41-2.76). Patients with both risk factors were approximately 3 times more likely to relapse than patients with neither.

Conclusions: The relapse rate among primary care patients treated for depression approached that of specialty samples, with more than one third reporting relapse in 1 year. Clinical characteristics can help target high-risk patients for relapse prevention efforts.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Antidepressive Agents / therapeutic use*
  • Cohort Studies
  • Depression / diagnosis
  • Depression / drug therapy*
  • Depression / prevention & control*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Primary Health Care
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Risk
  • Time Factors
  • Washington


  • Antidepressive Agents