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Estimating remission from untreated major depression: a systematic review and meta-analysis
Abstract
Background: Few studies have examined spontaneous remission from major depression. This study investigated the proportion of prevalent cases of untreated major depression that will remit without treatment in a year, and whether remission rates vary by disorder severity. Method: Wait-list controlled trials and observational cohort studies published up to 2010 with data describing remission from untreated depression at ⩽2-year follow-up were identified. Remission was defined as rescinded diagnoses or below threshold scores on standardized symptom measures. Nineteen studies were included in a regression model predicting the probability of 12-month remission from untreated depression, using logit transformed remission proportion as the dependent variable. Covariates included age, gender, study type and diagnostic measure. Results: Wait-listed compared to primary-care samples, studies with longer follow-up duration and older adult compared to adult samples were associated with lower probability of remission. Child and adolescent samples were associated with higher probability of remission. Based on adult samples recruited from primary-care settings, the model estimated that 23% of prevalent cases of untreated depression will remit within 3 months, 32% within 6 months and 53% within 12 months. Conclusions: It is undesirable to expect 100% treatment coverage for depression, given many will remit before access to services is feasible. Data were drawn from consenting wait-list and primary-care samples, which potentially over-represented mild-to-moderate cases of depression. Considering reported rates of spontaneous remission, a short untreated period seems defensible for this subpopulation, where judged appropriate by the clinician. Conclusions may not apply to individuals with more severe depression.
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“The meta-analysis by Whiteford et al. (2013) covering the rate of spontaneous remission in untreated depression showed that this rate decreases continuously over time.”
From Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review (2019) · cites this paper as Whiteford et al. 2013
In the citing paper
“Although approximately 23 % of cases of untreated depression remit spontaneously within three months, and 32 % in six months [18]”
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“The meta-analysis by Whiteford et al. (2013) covering the rate of spontaneous remission in untreated depression showed that this rate decreases continuously over time.”
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“The most likely explanation for this remission is the natural history of the condition, in particular for mild and moderate cases.(31) In addition it may be plausible that some non-specific elements, for example the participation in the research interviews or the enhancement of usual care, may have mediated symptom im…”
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“Second, the changes in depression and anxiety scores should be interpreted in light of other work that suggests over a 1-year period 50% individuals with CMD could experience natural remission [26].”
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“Yet, another metaanalysis confirmed that remission rates in untreated people with mostly moderate depression are surprisingly high: 23% remit within 3 months, 32% within 6 months and 53% within 12 months.(17) So now let us compare these remission rates in untreated people with those estimated for patients undergoing a…”
BackgroundResultSystematic review: Predicting adverse psychological outcomes after hand trauma
Ladds, E. C., Redgrave, N., Hotton, M., & Lamyman, M. J. (2017) · Journal of Hand Therapy · doi:10.1016/j.jht.2016.11.006 · Cited by 47
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“We are unable to rule out alternative explanations for observed effect sizes [placebo effects, spontaneous remission (Posternak & Miller, 2001; Whiteford et al., 2012)] and subsequently the observed effect sizes in this review cannot be directly compared to efficacy trials.”
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Trajectories of maternal depression: a 27-year population-based prospective study
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“Consistent with the very high burden of disease attributable to depression (Whiteford et al. 2013), one in every 6 days of the life of those in the high trajectory group is estimated to involve living with a depression which meets the DSM-IV clinical criteria.”
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“First, this may reflect spontaneous remission characterizing the natural course of depressive episodes (Whiteford et al., 2013).”
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“Finally, because we used routinely collected data and both programs were available across the nation, it was not feasible or ethical to include a control group and therefore we cannot discount the possibility that symptom improvement might have occurred in the absence of treatment [36].”
Method
Metadata
- Authors
- Whiteford, H. A., Harris, M. G., McKeon, G., Baxter, A., Pennell, C., Barendregt, J. J., & Wang, J.
- Affiliations
- The University of Queensland (AU)
- Queensland Centre for Mental Health Research (AU)
- University of Calgary (CA)
- Corresponding author
- Whiteford, H. A.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2012-08-10
- Volume
- 43
- Issue
- 8
- Pages
- 1569-1585
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2039156670
- Cited by
- 375
- References
- 72
- Citations by year
- 2026: 19 · 2025: 26 · 2024: 57 · 2023: 43 · 2022: 32 · 2021: 39 · 2020: 33 · 2019: 32 · 2018: 24 · 2017: 21 · 2016: 18 · 2015: 17 · 2014: 9 · 2013: 2 · 2012: 2
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Queensland
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, spontaneous regression, untreated depression, remission rate, disorder severity, primary care, child and adolescent depression, treatment coverage
- MeSH terms
- Adolescent, Adult, Child, Major Depressive Disorder, Humans, Remission, Spontaneous
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