SYMPTOM PROFILES OF DSM-IV-DEFINED REMISSION, RECOVERY, RELAPSE, AND RECURRENCE OF DEPRESSION: THE ROLE OF THE CORE SYMPTOMS
Article first published online: 11 MAY 2012
© 2012 Wiley Periodicals, Inc.
Depression and Anxiety
Volume 29, Issue 7, pages 638–645, July 2012
How to Cite
Conradi, H. J., Ormel, J. and de Jonge, P. (2012), SYMPTOM PROFILES OF DSM-IV-DEFINED REMISSION, RECOVERY, RELAPSE, AND RECURRENCE OF DEPRESSION: THE ROLE OF THE CORE SYMPTOMS. Depress. Anxiety, 29: 638–645. doi: 10.1002/da.21960
- Issue published online: 3 JUL 2012
- Article first published online: 11 MAY 2012
- Manuscript Accepted: 3 APR 2012
- Manuscript Revised: 28 FEB 2012
- Manuscript Received: 7 NOV 2011
- Dutch Organization for Scientific Research (NWO)
- Medical Sciences Program and Chronic Diseases Program
- Research Foundations of Health Insurance Company “Het Groene Land,” Regional Health Insurance Company (RZG)
- National Fund Mental Health (NFGV), and the University Medical Center Groningen
- symptom profiles;
- core symptoms;
- prospective study
Depression outcomes in research and clinical practice are commonly defined by the concepts of remission, recovery, relapse, and recurrence. Despite their widespread use, there has been little empirical examination of these concepts. Therefore, we investigated profiles of individual symptoms during each of these phases of depression.
In a 3-year prospective study of 267 depressed primary care patients, we established the presence or absence of the individual DSM-IV depressive symptoms week-by-week during DSM-IV-defined remissions, recoveries, relapses, and recurrences. We measured symptoms in 12 quarterly assessments using the Composite International Diagnostic Interview.
Remissions were characterized by double the proportion of time that the core symptoms were present compared to the initial phase of recoveries after a major depressive episode (MDE; 59 versus 32%; Z = –3.03; P = .002). Before a relapse, remissions again showed elevated levels of core symptoms in comparison to the final phase of recoveries before a recurrence (58 versus 26%; Z = –2.99; P = .003).
Compared with the initial and final phases of recoveries, remissions showed a consistently higher level of core symptoms. Clinically, this means that unresolved core symptoms in the direct aftermath of a MDE seem to constitute a risk for relapse and should be the target of preventive or augmented interventions.