Clinical and Psychosocial Origins of Chronic Depressive Episodes

BACKGROUND: We consider how well the psychosocial and clinical factors found to predict a chronic course for depressive episodes in the community, held for female psychiatric patients. METHOD: A consecutive series of depressed patients, aged 18 to 60, treated as in-patients, out-patients or day-patients at psychiatric departments of two London hospitals, were interviewed initially and at follow-up two years later. RESULTS: Indices of childhood adversity and current interpersonal difficulties predicted episodes taking a chronic course (of more than 12 months' duration). Half of the episodes associated with one or the other factor were chronic, compared with 22% of those with neither. The patients were at higher risk than the community series (75% v. 34%) and this explains their much greater rate of chronicity. There was also some evidence that social support reduced risk. Clinical features and the presence of a personality disorder were unrelated to chronicity. CONCLUSIONS: Similar psychosocial factors are important for predicting chronicity in both community and patient series.