The ten-year course of depression in primary care and long-term effects of psychoeducation, psychiatric consultation and cognitive behavioral therapy
Open accessAbstract
Background While the majority of depressed patients are treated in primary care, long-term follow-up data on the naturalistic course of depression and treatment effectiveness in this setting are scarce. This study examined the ten-year course of depression in primary care patients who had participated in a randomized clinical trial aiming at enhancement of depression outcomes.Methods Of the original sample (n=267), 166 patients participated in the ten-year follow-up; missingness was random. Four treatments were compared: (1) Care As Usual (CAU; n=51); (2) a Psychoeducational Prevention program (PEP; n=68); (3) Psychiatric Consultation followed by PEP (PC+PEP; n=21); and (4) brief Cognitive Behavioral Therapy followed by PEP (CBT+PEP; n=26). During the first three years interviews based on the Composite International Diagnostic Interview (CIDI) were three-monthly applied, the seven years thereafter were assessed with a once applied CIDI and a face-to-face life chart-based interview.Results During the ten-year follow-up 76.5% of the patients developed a new depressive episode, 83.4% used antidepressants (median usage 3.1 years), median depression diagnosis-free time was 9.0 years, and median residual symptom-free time 3.8 years. Treatments did not significantly differ on these outcomes, only trends appeared for lower depression severity for CBT+PEP, and, along with PEP, a higher proportion of symptom-free time.Limitations Assessment with the once applied life chart interview (a valid and reliable instrument) is less precise than the three-monthly assessments during the first three years.Conclusions The long-term course of depression in primary care is unfavorable, whereas treatment effects over time seem absent or small.
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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 [22]
Section 3.3 reports that 76.5% of patients had a new major depressive episode during the ten-year follow-up, supporting the upper end of the cited range. The paper does not report an 18% relapse rate, so it does not support the full 18–77% range on its own. (LLM, conf=0.87)
Experimental — accuracy not yet measuredUse of cultural idioms can be paired with depression screening tools to reduce screening time and improve accuracy of detection.
“Use of the idioms can also be paired with depression screening tools to reduce screening time and improve accuracy of detection. 122”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [122]
Some 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 [122]
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- Authors
- Conradi, H. J., Bos, E. H., Kamphuis, J. H., & de Jonge, P.
- Affiliations
- University of Amsterdam (NL)
- University of Groningen (NL)
- Corresponding author
- Conradi, Henk Jan
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 217
- Pages
- 174-182
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2598600906
- Cited by
- 25
- References
- 36
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 7 · 2021: 2 · 2020: 1 · 2019: 4 · 2018: 3 · 2017: 2
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- UvA-DARE (University of Amsterdam) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Netherlands Foundation for Mental Health
- Dutch Organization for Scientific Research
- Medical Sciences Program and Chronic Diseases Program
- Research Foundations of the Health Insurance Company ‘Het Groene Land’
- Regional Health Insurance Company
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- depression, primary care, psychoeducation, psychiatric consultation, cognitive behavioral therapy, depression relapse, antidepressant use, treatment effectiveness, residual depressive symptoms
- MeSH terms
- Adult, Antidepressive Agents, Depression, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Long-Term Care, Male, Mental Health, Middle Aged, Primary Health Care, Psychotherapy, Referral and Consultation, Time Factors, Cognitive Behavioral Therapy, Treatment Outcome
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