Ten-Year Prospective Follow-Up Study of the Naturalistic Course of Dysthymic Disorder and Double Depression
Abstract
OBJECTIVE: The purpose of this study was to describe the 10-year course and outcome of dysthymic disorder. METHOD: The authors conducted a naturalistic, prospective, longitudinal follow-up of 97 adults with early-onset dysthymic disorder and 45 adults with nonchronic major depressive disorder selected from consecutive admissions to several outpatient facilities. Follow-up data were obtained for 90% of the cohort. Assessments were conducted at baseline, 30, 60, 90, and 120 months. Measures included the Longitudinal Interval Follow-Up Evaluation and the Hamilton Depression Rating Scale. RESULTS: The Kaplan-Meier estimated recovery rate from dysthymic disorder was 73.9%, with a median time to recovery of 52 months. Among patients who recovered, the estimated risk of relapse into another period of chronic depression was 71.4%. Chronic depressive relapses took a variety of forms and were not limited to dysthymia. Nonetheless, the distinction between chronic and nonchronic forms of depression was relatively stable over the follow-up period. Mixed-effects models indicated that patients with dysthymic disorder experienced a significantly slower rate of improvement in symptoms over time and exhibited significantly greater depression at the 10-year point, compared to patients with nonchronic major depression. CONCLUSIONS: Dysthymic disorder has a protracted course and is associated with a high risk of relapse. The nature of chronic depressive episodes varies over time within individuals, indicating that the various manifestations of chronic depression in DSM-IV do not represent distinct disorders. However, the distinction between chronic and nonchronic forms of depression is relatively stable and may provide a useful basis for subtyping in genetic and neurobiological research.
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Other naturalistic long-term follow-up investigations show high rates of persistent illness and recurrences in dysthymia and panic disorder with agoraphobia.
“These findings are in accordance with other naturalistic long-term follow-up investigations showing high rates of persistent illness and recurrences in dysthymia and panic disorder with agoraphobia [2,3,8].”
From Helpful and hindering factors for remission in dysthymia and panic disorder at 9-year follow-up: A mixed methods study (2008) · cites this paper as [3]
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“These findings are in accordance with other naturalistic longterm follow-up investigations showing high rates of persistent illness and recurrences in dysthymia and panic disorder with agoraphobia [2,3,8].”
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- Authors
- Klein, D. N., Shankman, S. A., & Rose, S.
- Affiliations
- Stony Brook University (US)
- Venue
- American Journal of Psychiatry
- Published
- 2006-05
- Volume
- 163
- Issue
- 5
- Pages
- 872-880
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2084454764
- Cited by
- 194
- References
- 26
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 7 · 2023: 6 · 2022: 6 · 2021: 7 · 2020: 6 · 2019: 7 · 2018: 10 · 2017: 10 · 2016: 14 · 2015: 12 · 2014: 12 · 2013: 10 · 2012: 10
- FWCI
- 7.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH045757)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- dysthymia, double depression, chronic depression, course of depression, relapse, recovery, long-term outcomes, depression subtyping
- MeSH terms
- Adult, Chronic Disease, Major Depressive Disorder, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Terminology as Topic, Prognosis, Prospective Studies, Psychiatric Status Rating Scales, Recurrence, Risk Factors, Severity of Illness Index, Cohort Studies, Comorbidity, Survival Analysis, Age of Onset, Dysthymic Disorder, Diagnostic and Statistical Manual of Mental Disorders
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