Course of depression in a 10–year prospective study: Evidence for qualitatively distinct subgroups.
Open accessAbstract
The course of depressive disorders can vary considerable, with some individuals exhibiting a chronic course and poor outcomes, while others have a more episodic course and better outcomes. However, it is unclear whether degree of chronicity is continuous or reflects qualitatively distinct subgroups. Using data from a 5-wave, 10-year, naturalistic study of 127 depressed outpatients, we examined whether depression chronicity lies on a continuum or manifests natural boundaries. Spline regression was used to test 7 continuous and discontinuous models of the relationship between depression during the first follow-up interval and multiple outcomes at subsequent follow-ups. In order to further validate the findings, we also created empirically derived subgroups based on the results of the spline regression analyses and compared them on baseline clinical characteristics and long-term outcomes. There was a clear and consistent discontinuity indicating that for higher levels of chronicity during the first 30-month period, depression was linearly related to outcome; in contrast, for lower levels of chronicity, depression in the initial interval was unrelated to subsequent outcomes. The findings were strikingly consistent across the 4 follow-up evaluations using multiple outcomes and goodness-of-fit indices. In addition, the chronic group--as defined by the first follow-up period--exhibited more baseline chronic depression, anxiety and personality disorders, family history of dysthymia, and childhood adversity, and was more likely to attempt suicide and be hospitalized during follow-up, than the nonchronic group. Results suggest that there are qualitatively distinct classes of patients with more and less chronic depressions, and support the utility of longitudinal course as a means of parsing depression into more homogeneous subgroups.
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Long-term prospective data has identified qualitatively distinct populations within patients with major depressive disorder.
“Long-term prospective data 25 has identified qualitatively distinct populations within patients with major depressive disorder”
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Hajcak, G., Santopetro, N. J., & Okuda, K. (2024) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2024.111233 · Cited by 4 · see citing works
Les progrès dans la réalisation de la classification quantitative de la psychopathologie
Krueger, R. F., Kotov, R., Watson, D., Forbes, M. K., Eaton, N. R., Ruggero, C. J., Simms, L. J., Widiger, T. A., Achenbach, T. M., Bach, B., et al. (2021) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2020.11.015 · Cited by 4 · see citing works
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Yuan, B., Li, J., Li, K., & Chen, M. (2022) · Journal of Biosocial Science · doi:10.1017/s002193202200027x · Cited by 4 · see citing works
Persistent Depressive Disorder: Commentary on Parker and Malhi
Klein, D. N. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743719860823 · Cited by 4 · see citing works
Self-citationAtagün, M. İ. (2025) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.70221 · Cited by 3 · see citing works
Olgiati, P., Luca, M., Luca, A., Messina, A., Souery, D., Kasper, S. F., Zohar, J., Montgomery, S., Ferentinos, P. P., Rujescu, D., et al. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121308 · Cited by 4 · see citing works
Childhood trauma, coping, and depressive symptoms among older adults
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Johnson, D. E., Rodrigues, N. B., Mansur, R. B., McIntyre, R. S., & Rosenblat, J. D. (2025) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13812 · Cited by 3 · see citing works
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Kallen, A. M., Brush, C. J., Santopetro, N. J., Patrick, C. J., & Hajcak, G. (2024) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-024-01267-w · Cited by 2 · see citing works
Effects of neuroticism on suicide risk in major depressive disorder and bipolar disorder
Xing, Y., Li, T., Mao, Z., Zhao, L., Sun, Y., Jiang, Q., Wang, C., & Bo, Q. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1527054 · Cited by 2 · see citing works
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Course in Diagnosis of Psychotic Disorders: Research Agenda
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Differences between persistent and episodic depression in processing novel positive information
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What do personality tests say about mood disorders? A systematic review
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Distinguishing Chronic and Non-Chronic Depression: A Clinical Profile and Symptom Networks Approach
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Zhang, Y., Wang, J., Song, Y., Long, S., Li, Y. W., Hu, T., Zhang, Q., Jin, W., Li, B., & Liu, C. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1841572
- Authors
- Klein, D. N., & Kotov, R.
- Affiliations
- Stony Brook University (US)
- Venue
- Journal of Abnormal Psychology
- Published
- 2016-04
- Volume
- 125
- Issue
- 3
- Pages
- 337-348
- ISSN
- 0021-843X (ISSN-L)
- 1939-1846
- PMC
- PMC4821749
- OpenAlex
- W2347188545
- Cited by
- 62
- References
- 60
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 6 · 2023: 5 · 2022: 9 · 2021: 4 · 2020: 6 · 2019: 8 · 2018: 5 · 2017: 5 · 2015: 1
- FWCI
- 8.54
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Abnormal Psychology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (RO1 MH45757, RO1 MH094398)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- depression, chronic depression, course of depression, long-term outcomes, suicide attempts, hospitalization, childhood adversity, anxiety, personality disorders, longitudinal course
- MeSH terms
- Adolescent, Adult, Major Depressive Disorder, Depressive Disorder, Major, Female, Humans, Longitudinal Studies, Male, Middle Aged, Models, Theoretical, Personality, Prospective Studies, Severity of Illness Index, Suicide, Disease Progression, Young Adult, Symptom Assessment
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