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Depression is increasingly recognized as a chronic and relapsing disorder. However, an important minority of patients who start treatment for their major depressive episode recover to euthymia. It is clinically important to be able to predict such individuals.
The study is a secondary analysis of a recently completed pragmatic megatrial examining first- and second-line treatments for hitherto untreated episodes of non-psychotic unipolar major depression (n = 2011). Using the first half of the cohort as the derivation set, we applied multiply-imputed stepwise logistic regression with backward selection to build a prediction model to predict remission, defined as scoring 4 or less on the Patient Health Quetionnaire-9 at week 9. We used three successively richer sets of predictors at baseline only, up to week 1, and up to week 3. We examined the external validity of the derived prediction models with the second half of the cohort.
In total, 37.0% (95% confidence interval 34.8–39.1%) were in remission at week 9. Only the models using data up to week 1 or 3 showed reasonable performance. Age, education, length of episode and depression severity remained in the multivariable prediction models. In the validation set, the discrimination of the prediction model was satisfactory with the area under the curve of 0.73 (0.70–0.77) and 0.82 (0.79–0.85), while the calibration was excellent with non-significant goodness-of-fit χ2 values (p = 0.41 and p = 0.29), respectively.
Patients and clinicians can use these prediction models to estimate their predicted probability of achieving remission after acute antidepressant therapy.
The value of family psychoeducation for schizophrenia has been well
established, and indications for its use have recently expanded to
include bipolar affective disorder. However, no study to date has
adequately examined its use in depression.
To examine family psychoeducation in the maintenance treatment of
depression and to investigate the influence of the family's expressed
emotion (EE) on its effectiveness.
Of 103 patients diagnosed with major depression and their primary family
members, 57 pairs provided written informed consent. The pairs were
randomly allocated to the intervention (n = 25) or
control (n = 32). One family in the intervention group
and two in the control group withdrew their consent after randomisation.
The intervention group underwent four psychoeducation sessions consisting
of didactic lectures about depression and group problem-solving focusing
on how to cope in high-EE situations. Patients did not attend these
sessions. Patients in both the intervention and control groups received
treatment as usual. The families' EE levels were evaluated through
Five-Minute Speech Samples. The primary outcome was relapse.
Time to relapse was statistically significantly longer in the
psychoeducation group than in the control group (Kaplan–Meier survival
analysis, P = 0.002). The relapse rates up to the
9-month follow-up were 8% and 50% respectively (risk ratio 0.17, 95% CI
0.04–0.66; number needed to treat 2.4, 95% CI 1.6–4.9). In Cox
proportional hazard analysis, baseline EE did not moderate the
effectiveness of the intervention.
Family psychoeducation is effective in the prevention of relapse in adult
patients with major depression.
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