The Ten-Year Course of Depression in Primary Care and Long-term Effects of Psychoeducation, Psychiatric Consultation and Cognitive Behavioral Therapy

Abstract Background While the majority of depressed patients are treated in primary care, long-term follow-up data on the naturalistic course of depression and treatment effectiveness in this setting are scarce. This study examined the ten-year course of depression in primary care patients who had participated in a randomized clinical trial aiming at enhancement of depression outcomes. Methods Of the original sample ( n =267), 166 patients participated in the ten-year follow-up; missingness was random. Four treatments were compared: (1) Care As Usual (CAU; n =51); (2) a Psychoeducational Prevention program (PEP; n =68); (3) Psychiatric Consultation followed by PEP (PC+PEP; n =21); and (4) brief Cognitive Behavioral Therapy followed by PEP (CBT+PEP; n =26). During the first three years Composite International Diagnostic Interview (CIDI) based interviews were three-monthly applied, the seven years thereafter were assessed with a once applied CIDI and face-to-face life chart-based interview. Results During the ten-year follow-up 76.5% of the patients developed a new depressive episode, 83.4% used antidepressants (median usage 3.1 years), median depression diagnosis-free time was 9.0 years, and median residual symptom-free time 3.8 years. Treatments did not significantly differ on these outcomes, only trends appeared for lower depression severity for CBT+PEP, and, along with PEP, a higher proportion of symptom-free time. Limitations Assessment with the once applied life chart interview (a valid and reliable instrument) is less precise than the three-monthly assessments during the first three years. Conclusions The long-term course of depression in primary care is unfavorable, whereas treatment effects over time seem absent or small.