Recurrence of major depressive disorder across different treatment settings: Results from the NESDA study
Open accessAbstract
Objective Examine time to recurrence of major depressive disorder (MDD) across different treatment settings and assess predictors of time to recurrence of MDD.Methods Data were from 375 subjects with a MDD diagnosis from the Netherlands Study of Depression and Anxiety (NESDA). The study sample was restricted to subjects with a remission of at least three months. These subjects were followed until recurrence or the end of the two year follow-up. DSM-IV based diagnostic interviews and Life Chart Interviews were used to assess time to recurrence of MDD across treatment settings. Predictors of time to recurrence were determined using Cox's proportional hazards analyses.Results Although trends indicated a slightly higher rate of and shorter time to recurrence in specialized mental health care, no significant difference in recurrence rate (26.8% versus 33.5%, p=0.23) or in time to recurrence (controlled for covariates) of MDD was found between respondents in specialized mental health care and respondents treated in primary care (average 6.6 versus 5.5 months, p=0.09). In multivariable analyses, a family history of MDD and previous major depressive episodes were associated with a shorter time to recurrence. Predictors did not differ across treatment settings.Limitations The study sample may not be representative of the entire population treated for MDD in specialized mental health care.Conclusions Health care professionals in both settings should be aware of the same risk factors since the recurrence risk and its predictors appeared to be similar across settings.
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In major depressive disorder, 18-77% of patients experienced a relapse.
“Likewise, with regard to major depressive disorder (MDD), 18–77% of patients experienced a relapse [22–28].”
From Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as [24]
Section 3.2 (page unavailable) reports that 26.8% of patients in primary care and 33.5% in specialized mental health care experienced a recurrence during two years. Those figures fall within the cited range, but this paper does not report its 18% or 77% endpoints, and it describes recurrence after remission rather than relapse. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSome studies have suggested that symptoms such as appetite or weight changes do not distinguish between depressed and non-depressed outside of affluent high-resource settings, as evidenced by studies in Turkey, Nigeria, and Nepal.
“To date, some studies have suggested that symptoms such as appetite or weight changes do not distinguish between depressed and nondepressed outside of affluent high-resource settings, as evidenced by studies in Turkey, Nigeria, and Nepal. 122-124”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [123]
The relapse rate in this cohort is similar to those reported in other clinical settings and in meta-analyses of RCTs, which have shown relapse rates of 21% to 49%.
“This relapse rate is similar to those reported in other clinical settings7,22 and in meta-analyses of RCTs,6,8 which have shown that those who remain on antidepressants following remission had relapse rates of 21% to 49%.”
Between one-fifth and one-half of patients in remission from a depressive episode will suffer a recurrence within 2 years.
“Studies indicate that between one-fifth to one-half of patients in remission from a depressive episode will suffer a recurrence within 2 years.4–10”
Prior research has investigated a limited range of individual predictors, many of which are related to demographics and clinical history.
“prior research has investigated a limited range of individual predictors, many of which are related to demographics and clinical history.7,9,18”
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- Authors
- Hardeveld, F., Spijker, J., De Graaf, R., Hendriks, S. M., Licht, C. M. M., Nolen, W. A., Penninx, B. W. J. H., & Beekman, A. T. F.
- Affiliations
- Pro Persona (NL)
- Amsterdam Public Health (NL)
- University Medical Center Groningen (NL)
- Corresponding author
- Hardeveld, Florian
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2013-05
- Volume
- 147
- Issue
- 1-3
- Pages
- 225-231
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2096329254
- Cited by
- 95
- References
- 42
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 8 · 2023: 7 · 2022: 7 · 2021: 10 · 2020: 10 · 2019: 10 · 2018: 9 · 2017: 9 · 2016: 4 · 2015: 2 · 2014: 4 · 2013: 2
- FWCI
- 3.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, recurrence, time to recurrence, treatment setting, specialized mental health care, primary care, predictors of recurrence, family history of depression, remission, NESDA
- MeSH terms
- Adult, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Mental Health Services, Netherlands, Primary Health Care, Recurrence, Time Factors
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