Estimating remission from untreated major depression: a systematic review and meta-analysis

Whiteford, H. A., Harris, M. G., McKeon, G., Baxter, A., Pennell, C., Barendregt, J. J. and Wang, J. (2013) Estimating remission from untreated major depression: a systematic review and meta-analysis. Psychological Medicine, 43 8: 1569-1585. doi:10.1017/S0033291712001717


Author Whiteford, H. A.
Harris, M. G.
McKeon, G.
Baxter, A.
Pennell, C.
Barendregt, J. J.
Wang, J.
Title Estimating remission from untreated major depression: a systematic review and meta-analysis
Journal name Psychological Medicine   Check publisher's open access policy
ISSN 0033-2917
1469-8978
Publication date 2013-08-01
Year available 2012
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1017/S0033291712001717
Volume 43
Issue 8
Start page 1569
End page 1585
Total pages 17
Place of publication Cambridge, United Kingdom
Publisher Cambridge University Press
Collection year 2013
Language eng
Formatted abstract
Background: Few studies have examined spontaneous remission from major depression. This study investigated the proportion of prevalent cases of untreated major depression that will remit without treatment in a year, and whether remission rates vary by disorder severity.

Method: Wait-list controlled trials and observational cohort studies published up to 2010 with data describing remission from untreated depression at ≤2-year follow-up were identified. Remission was defined as rescinded diagnoses or below threshold scores on standardized symptom measures. Nineteen studies were included in a regression model predicting the probability of 12-month remission from untreated depression, using logit transformed remission proportion as the dependent variable. Covariates included age, gender, study type and diagnostic measure.

Results: Wait-listed compared to primary-care samples, studies with longer follow-up duration and older adult compared to adult samples were associated with lower probability of remission. Child and adolescent samples were associated with higher probability of remission. Based on adult samples recruited from primary-care settings, the model estimated that 23% of prevalent cases of untreated depression will remit within 3 months, 32% within 6 months and 53% within 12 months.

Conclusions: It is undesirable to expect 100% treatment coverage for depression, given many will remit before access to services is feasible. Data were drawn from consenting wait-list and primary-care samples, which potentially over-represented mild-to-moderate cases of depression. Considering reported rates of spontaneous remission, a short untreated period seems defensible for this subpopulation, where judged appropriate by the clinician. Conclusions may not apply to individuals with more severe depression.
Keyword Major depressive disorder
Meta-analysis
Natural history
Spontaneous remission
Systematic review
Cognitive-behavioral-therapy
International primary-care
Wait-list control
Mental-health
Spontaneous improvement
Cost-effectiveness
Perceived need
Disorders
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online: 10 August 2012.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
School of Public Health Publications
 
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Created: Thu, 17 Jan 2013, 00:46:37 EST by Geraldine Fitzgerald on behalf of School of Public Health