Skip to main content

Bouncing back: remission from depression in a 12-year panel study of a representative Canadian community sample

Social Psychiatry and Psychiatric Epidemiology volume 49, pages 903–910 (2014)Cite this article

Abstract

Purpose

This study sought to investigate time to remission from depression in a community-based sample of adults followed for 12 years.

Methods

Data were derived from the National Population Health Survey (1994/5–2006/7 and 1996/7–2008/9). Fully 1,128 adults were included who were depressed at baseline according to DSM-III/CIDI-SF criteria. Kaplan–Meier and Cox proportional hazards procedures were used to determine time to remission and the demographic (e.g., gender and marital status), psychosocial (e.g., social support and adverse childhood experience) and health-related (e.g., pain, health conditions and alcohol use) factors with which it is associated.

Results

More than three quarters of the sample (77 %) no longer screened positive for depression at 2 years, and nearly the entire sample (94 %) had remitted by 12 years. Adverse childhood experiences (i.e., childhood abuse and parental additions), lack of social support, the presence of pain and health conditions (i.e., migraines, arthritis and back pain) each predicted more time to remission. The only factor associated with time to remission in the multivariate analysis was a history of childhood physical abuse.

Conclusions

Most community members with depression get better after 2 years and nearly all will have remitted, at least once, by 12 years. The results of this study may help guide the development of interventions for chronic depression that focus on early prevention of childhood abuse.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370:851–858

    Article  PubMed  Google Scholar 

  2. World Health Organization (2004) The global burden of disease: 2004 update. http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html. Accessed April 9, 2013

  3. Casacalenda N, Perry JC, Looper K (2002) Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy, and control conditions. Am J Psychiatry 159:1354–1360

    Article  PubMed  Google Scholar 

  4. Dawson MY, Michalak EE, Waraich P, Anderson JE, Lam RW (2004) Is remission of depressive symptoms in primary care a realistic goal? A meta-analysis. BMC Fam Pract 5:19

    Article  PubMed Central  PubMed  Google Scholar 

  5. Trivedi MH, Corey-Lisle PK, Guo Z, Lennox RD, Pikalov A, Kim E (2009) Remission, response without remission, and nonresponse in major depressive disorder: impact on functioning. Int Clin Psychopharmacol 24:133–138

    Article  PubMed  Google Scholar 

  6. Hirschfeld RMA (2000) Psychosocial Predictors of Outcome in Depression. http://www.acnp.org/G4/GN401000107/. Accessed June 20, 2013

  7. Tranter R, O’Donovan C, Chandarana P, Kennedy S (2002) Prevalence and outcome of partial remission in depression. J Psychiatry Neurosci 27:241–247

    PubMed Central  PubMed  Google Scholar 

  8. Donohue JM, Pincus HA (2007) Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. Pharmacoeconomics 25:7–24

    Article  PubMed  Google Scholar 

  9. Bakish D (2001) New standard of depression treatment: remission and full recovery. J Clin Psychiatry 62(Suppl 26):5–9

    PubMed  Google Scholar 

  10. Keller MB (2003) Past, present, and future directions for defining optimal treatment outcome in depression: remission and beyond. JAMA 289:3152–3160

    Article  PubMed  Google Scholar 

  11. Richards D (2011) Prevalence and clinical course of depression: a review. Clin Psychol Rev 31:1117–1125

    Article  PubMed  Google Scholar 

  12. Holzel L, Harter M, Reese C, Kriston L (2011) Risk factors for chronic depression—a systematic review. J Affect Disord 129:1–13

    Article  PubMed  Google Scholar 

  13. Conradi HJ, de Jonge P, Ormel J (2008) Prediction of the three-year course of recurrent depression in primary care patients: different risk factors for different outcomes. J Affect Disord 105:267–271

    Article  PubMed  Google Scholar 

  14. Rhebergen D, Lamers F, Spijker J, de Graaf R, Beekman AT, Penninx BW (2012) Course trajectories of unipolar depressive disorders identified by latent class growth analysis. Psychol Med 42:1383–1396

    Article  CAS  PubMed  Google Scholar 

  15. Szadoczky E, Rozsa S, Zambori J, Furedi J (2004) Predictors for 2-year outcome of major depressive episode. J Affect Disord 83:49–57

    Article  PubMed  Google Scholar 

  16. Bockting CL, Spinhoven P, Koeter MW, Wouters LF, Schene AH, Depression Evaluation Longitudinal Therapy Assessment Study Group (2006) Prediction of recurrence in recurrent depression and the influence of consecutive episodes on vulnerability for depression: a 2-year prospective study. J Clin Psychiatry 67:747–755

    Article  PubMed  Google Scholar 

  17. Nelson JC, Zhang Q, Deberdt W, Marangell LB, Karamustafalioglu O, Lipkovich IA (2012) Predictors of remission with placebo using an integrated study database from patients with major depressive disorder. Curr Med Res Opin 28:325–334

    Article  CAS  PubMed  Google Scholar 

  18. Spijker J, de Graaf R, Bijl RV, Beekman AT, Ormel J, Nolen WA (2004) Determinants of persistence of major depressive episodes in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). J Affect Disord 81:231–240

    Article  PubMed  Google Scholar 

  19. van den Brink RH, Ormel J, Tiemens BG, Smit A, Jenner JA, van der Meer K et al (2002) Predictability of the one-year course of depression and generalized anxiety in primary care. Gen Hosp Psychiatry 24:156–163

    Article  PubMed  Google Scholar 

  20. Meyers B (2002) Predictors of early recovery from major depression among persons admitted to community-based clinics: an observational study. Arch Gen Psychiatry 59:729–735

    Article  PubMed  Google Scholar 

  21. De Almeida Fleck MP, Simon G, Herrman H, Bushnell D, Martin M, Patrick D et al (2005) Major depression and its correlates in primary care settings in six countries. 9-month follow-up study. British J Psychiatry 186:41–47

    Article  Google Scholar 

  22. Barkow K, Maier W, Ustun TB, Gansicke M, Wittchen HU, Heun R (2003) Risk factors for depression at 12-month follow-up in adult primary health care patients with major depression: an international prospective study. J Affect Disord 76:157–169

    Article  PubMed  Google Scholar 

  23. Bracke P (2000) The three-year persistence of depressive symptoms in men and women. Soc Sci Med 51:51–64

    Article  CAS  PubMed  Google Scholar 

  24. Conradi H, DeJonge P, Ormel J (2008) Prediction of the three-year course of recurrent depression in primary care patients: different risk factors for different outcomes. J Affect Disord 105:267–271

    Article  PubMed  Google Scholar 

  25. Melartin TK, Rytsala HJ, Leskela US, Lestela-Mielonen PS, Sokero TP, Isometsa ET (2004) Severity and comorbidity predict episode duration and recurrence of DSM-IV major depressive disorder. J Clin Psychiatry 65:810–819

    Article  PubMed  Google Scholar 

  26. Nasser EH, Overholser JC (2005) Recovery from major depression: the role of support from family, friends, and spiritual beliefs. Acta Psychiatr Scand 111:125–132

    Article  CAS  PubMed  Google Scholar 

  27. Harkness KL, Bagby RM, Kennedy SH (2012) Childhood maltreatment and differential treatment response and recurrence in adult major depressive disorder. J Consult Clin Psychol 80:342–353

    Article  PubMed  Google Scholar 

  28. Nanni V, Uher R, Danese A (2012) Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. Am J Psychiatry 169:141–151

    Article  PubMed  Google Scholar 

  29. Miniati M, Rucci P, Benvenuti A, Frank E, Buttenfield J, Giorgi G et al (2010) Clinical characteristics and treatment outcome of depression in patients with and without a history of emotional and physical abuse. J Psychiatr Res 44:302–309

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Ciudad A, Alvarez E, Roca M, Baca E, Caballero L, Garcia de Polavieja P et al (2012) Early response and remission as predictors of a good outcome of a major depressive episode at 12-month follow-up: a prospective, longitudinal, observational study. J Clin Psychiatry 73:185–191

    Article  PubMed  Google Scholar 

  31. Fuller-Thomson E, Battiston M, Gadalla T, Shaked Y, Raza F (in press) Remission from depression among adults with arthritis: a 12-year follow-up of a population-based study. Depress Res Treat. http://www.hindawi.com/journals/drt/aip/

  32. Kroenke K, Shen J, Oxman TE, Williams JW Jr, Dietrich AJ (2008) Impact of pain on the outcomes of depression treatment: results from the RESPECT trial. Pain 134:209–215

    Article  PubMed  Google Scholar 

  33. Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K et al (2000) Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med 62:633–638

    Article  CAS  PubMed  Google Scholar 

  34. Kloiber S, Ising M, Reppermund S, Horstmann S, Dose T, Majer M et al (2007) Overweight and obesity affect treatment response in major depression. Biol Psychiatry 62:321–326

    Article  PubMed  Google Scholar 

  35. Boschloo L, Vogelzangs N, van den Brink W, Smit JH, Veltman DJ, Beekman AT et al (2012) Alcohol use disorders and the course of depressive and anxiety disorders. Br J Psychiatry 200:476–484

    Article  PubMed  Google Scholar 

  36. Health Statistics Division, Statistics Canada (1995) National Population Health Survey 1994-95: Overview. http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SurvId=3225&SurvVer=0&SDDS=3225&InstaId=15280&InstaVer=1&lang=en&db=imdb&adm=8&dis=2. Accessed June 20, 2013

  37. Statistics Canada (2012) National Population Health Survey-Household Component—Longitudinal (NPHS). http://www23.statcan.gc.ca:81/imdb/p2SV.pl?Function=getSurvey&SDDS=3225&lang=en&db=imdb&adm=8&dis=2. Accessed March 11, 2013

  38. Kessler RC, Andrews G, Mroczek D, Uston B, Wittchen H (1998) The World Health Organization Composite International Diagnostic Interview Short Form (CIDI-SF). Int J Methods Psychiatr Res 7:171–185

    Article  Google Scholar 

  39. Andrews G, Peters L (1998) The psychometric properties of the composite international diagnostic interview. Soc Psychiatry Psychiatr Epidemiol 33:80–88

    Article  CAS  PubMed  Google Scholar 

  40. Mulder RT, Joyce PR, Frampton CM, Luty SE, Sullivan PF (2006) Six months of treatment for depression: outcome and predictors of the course of illness. Am J Psychiatry 63:95–100

    Article  Google Scholar 

  41. Oldehinkel AJ, Ormel J, Neeleman J (2000) Predictors of time to remission from depression in primary care patients: do some people benefit more from positive life changes than others? J Abnorm Psychol 109:299–307

    Article  CAS  PubMed  Google Scholar 

  42. Parker G, Wilhelm K, Mitchell P, Gladstone G (2000) Predictors of 1-year outcome in depression. Aust N Z J Psychiatry 34:56–64

    Article  CAS  PubMed  Google Scholar 

  43. Penza KM, Heim C, Nemeroff CB (2003) Neurobiological effects of childhood abuse: implications for the pathophysiology of depression and anxiety. Arch Women’s Ment Health 6:15–22

    Article  CAS  Google Scholar 

  44. McCrory E, De Brito SA, Viding E (2012) The link between child abuse and psychopathology: a review of neurobiological and genetic research. J R Soc Med 105:151–156

    Article  PubMed  Google Scholar 

  45. Shonkoff JP, Boyce WT, McEwen BS (2009) Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA 301:2252–2259

    Article  CAS  PubMed  Google Scholar 

  46. Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P (2012) Consortium for the European Review of Social Determinants of Health and the Health Divide. WHO European review of social determinants of health and the health divide. Lancet 380:1011–1029

    Article  PubMed  Google Scholar 

  47. Scott KL, Lishak V (2012) Intervention for maltreating fathers: statistically and clinically significant change. Child Abuse Negl 36:680–684

    Article  PubMed  Google Scholar 

  48. Mead N, Lester H, Chew-Graham C, Gask L, Bower P (2010) Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis. Br J Psychiatr 196:96–101

    Article  Google Scholar 

  49. Hardt J, Rutter M (2004) Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. J Child Psychol Psychiatry 45:260–273

    Article  PubMed  Google Scholar 

  50. Lizardi H, Klein DN (2005) Long-term stability of parental representations in depressed outpatients utilizing the parental bonding instrument. J Nerv Ment Dis 193:183–188

    Article  PubMed  Google Scholar 

  51. Andrade L, Caraveo-Anduaga J, Berglund P, Bijl R, De Graaf R, Vollebergh W et al (2003) The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res 12:3–21

    Article  PubMed  Google Scholar 

  52. Kohn R, Saxena S, Levav I, Saraceno B (2004) The treatment gap in mental health care. Bull World Health Organ 82:858–866

    PubMed Central  PubMed  Google Scholar 

  53. Messias E, Eaton WW, Grooms AN (2011) Income inequality and depression prevalence across the United States: an ecological study. Psychiatr Serv 62:710–712

    Article  PubMed  Google Scholar 

  54. Chen YY, Subramanian SV, Acevedo-Garcia D, Kawachi I (2005) Women’s status and depressive symptoms: a multilevel analysis. Soc Sci Med 60:49–60

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The first author (Esme Fuller-Thomson) would like to gratefully acknowledge support received from the Sandra Rotman Endowed Chair in Social Work. We wish to thank Statistics Canada and the Social Sciences and Humanities Council of Canada for permission to access the longitudinal form of the National Population Health Survey via the Research Data Center (RDC) at the University of Toronto. We are also grateful to the staff at the Toronto RDC for their help in accessing the data. The opinions expressed herein are our own and do not represent the views of Statistics Canada.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W, Toronto, ON, M5S 1V4, Canada

    Esme Fuller-Thomson, Marla Battiston & Tahany M. Gadalla

  2. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Sarah Brennenstuhl

Authors
  1. Esme Fuller-Thomson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marla Battiston
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tahany M. Gadalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarah Brennenstuhl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Esme Fuller-Thomson.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fuller-Thomson, E., Battiston, M., Gadalla, T.M. et al. Bouncing back: remission from depression in a 12-year panel study of a representative Canadian community sample. Soc Psychiatry Psychiatr Epidemiol 49, 903–910 (2014). https://doi.org/10.1007/s00127-013-0814-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-013-0814-8

Keywords

  • Survival analysis
  • CIDI-SF
  • Childhood abuse
  • Adverse childhood experiences