Risk Factors Associated with Relapse in Major Depressive Disorder in Primary Care Patients: A Systematic Review

Major Depressive Disorder (MDD) is highly recurrent. Most patients with MDD are treated in the Primary Care (PC) setting. The purpose of this systematic review was to identify risk factors associated with relapse of MDD in PC. A systematic review of PsycINFO, PubMed, Web of Science and ScienceDirect, from 1978 to 2019, following PRISMA guidelines was conducted. Eight studies fulfilling the eligibility criteria and 12 risk factors associated with relapse of MDD were found. Patients who showed a higher frequency of relapse were: 1) those with higher scores in neuroticism, disability, current MDD episode severity, and childhood abuse; 2) lower scores on extraversion, self-esteem, emotional role, physical functioning; 3) history of MDD relapse; 4) comorbidity; and 5) poorer adherence to antidepressant medication (ADM). In terms of treatment, ADM combined with cognitive behavioural therapy and psychoeducation was reported to produce fewer relapses, as was mindfulness-based cognitive therapy for patients with a higher score in childhood abuse. Despite the very varied nature of the studies, different risk factors associated with relapse were identified. However, more research is needed on this important problem, with randomized controlled trials.