Abstract
Objective
The study describes course and outcome over 25 years in depressed and non-depressed men and women from a large community study. Outcome measures covered psychopathology, disability, and impaired functioning.
Method
A depressive syndrome (depressed mood and three additional depressive symptoms) was defined and compared to a control condition without depressive symptoms in the seven days preceding baseline assessment. Assessments focused on three time points: baseline survey, 5-year follow-up, and 25-year follow-up. Self-rating scales as well as expert-rating interviews yielded data on a wide range of social and psychopathological risk factors and outcome measures.
Results
Among participants of all three waves (N = 838), the baseline prevalence for depressive syndrome was 18.1%. Depressive symptoms manifest at the first wave had substantial impact over the 25-year study. Subjects with a depressive syndrome were predisposed for later adverse mental health outcomes, more disability in social domains and reduced functionality. No long-term increase or decrease of the prevalence of the depressive syndrome was observed.
Conclusion
There is a persistent and long lasting impact of depressive syndrome, irrespective of diagnostic status, in the general population. Our results underscore the importance of sub-syndromal depressive syndrome when estimating the risk of future mental disorders and functional impairment in the long-term.
Similar content being viewed by others
References
Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lepine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martinez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacin C, Romera B, Taub N, Vollebergh WA (2004) Disability and quality of life impact of mental disorders in Europe: results from the European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 420:38–46
American Psychiatric Association (APA) (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edn (text revision). American Psychiatric Association, Washington, DC
Angst J (1996) Comorbidity of mood disorders: a longitudinal prospective study. Br J Psychiatry 168:58–67
Angst J, Merikangas K (1997) The depressive spectrum: diagnostic classification and course. J Aff Dis 45:31–40
Bell RA, Kravitz RL, Wilkes MS (2000) Direct-to-consumer prescription drug advertising, 1989–1998. A content analysis of conditions, targets, inducements, and appeals. J Fam Pract 49:329–335
Broadhead WE, Blazer DG, George LK, Tse LK (1990) Depression, disability days and days lost from work in a prospective epidemiologic survey. JAMA 264:2524–2528
Chen LS, Eaton WW, Gallo JJ, Nestadt G, Crum R (2000) Empirical examination of current depression categories in a population-based study: symptoms, course, and risk factors. Am J Psych 157:573–580
Clare AS, Cairns VE (1978) Design, development and use of standardized interview to assess social maladjustment and dysfunction in community studies. Psychol Med 8:589–604
Compton WM, Conway KP, Stinson FS, Grant BF (2006) Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991–1992 and 2001–2002. Am J Psychiatry 163:2141–2147
DAK Gesundheitsreport (2005) DAK Versorgungsmanagement, Hamburg
Dilling H, Weyerer S (1984) Psychische Erkrankungen in der Bevölkerung bei Erwachsenen und Jugendlichen. In: Dilling H, Weyerer S, Castell R (eds) Psychische Erkrankungen in der Bevölkerung. Enke Verlag, Stuttgart, pp 1–122
Eaton WW, Ritter C (1988) Distinguishing anxiety and depression with field survey data. Psychol Med 18(1):155–166
Eaton WW, Kalaydjian A, Scharfstein DO, Mezuk B, Ding Y (2007) Prevalence and incidence of depressive disorder: the Baltimore ECA follow-up, 1981–2004. Acta Psychiatr Scand 116:182–188
Feuerlein W, Ringer C, Küfner H, Antons K (1977) Diagnose des Alkoholismus: per Münchner Alkoholismustest (MALT). MMW Munch Med Wochenschr 119:1275–1282
Fichter MM (1990) Verlauf psychischer Erkrankungen in der Bevölkerung. Springer, Heidelberg
Fichter MM, Narrow WE, Roper MT, Rehm J, Elton M, Rae DS, Locke BZ, Regier DA (1996) Prevalence of mental illness in Germany and the USA: comparison of the upper Bavarian study and the epidemiologic catchment area program. J Nerv Ment Dis 184:598–606
Goldberg DP, Cooper P, Eastwood RR, Kedward MB, Shepherd M (1970) A standardized psychiatric interview for use in community surveys. Br J Prev Soc Med 24:18–23
Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Berglund PA, Corey-Lisle PK (2003) The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry 64:465–1475
Hagnell O, Lanke J, Rorsman B, ÖjesjÖ L (1982) Are we entering an age of melancholy? Depressive illness in a prospective epidemiological study over 25 years. Psychol Med 12:279–289
Hagnell O (1989) Repeated incidence and prevalence studies of mental disorders in a total population followed during 25 years. The Lundby Study, Sweden. Acta Psychiatr Scand (Suppl) 348:61–77
Hagnell O, Gräsbeck A (1990) Comorbidity of anxiety and depression in the Lundby 25-year prospective study: the pattern of subsequent episodes. In: Maser JD, Cloninger CR (eds) Comorbidity of mood and anxiety disorders. American Psychiatric Press Inc., Arlington, pp 139–152
Hagnell O, ÖjesjÖ L, Otterbeck L, Rorsman B (1994) Prevalence of mental disorders, personality traits and mental complaints in the Lundby Study. Scand J Soc Med (Suppl) 50:7–72
Judd LJ, Paulus MP, Wells KB, Rapaport MH (1996) Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. Am J Psych 153:1411–1417
Judd LL, Schettler PJ, Akiskal HS (2002) The prevalence, clinical relevance, and public health significance of subthreshold depressions. Psychiatr Clin North Am 25(4):685–698
Kennedy N, Abbott R, Paykel ES (2003) Remission and recurrence of depression in the maintenance era: long-term outcome in a Cambridge cohort. Psychol Med 33(5):827–838
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the national comorbidity survey. Arch Gen Psychiatry 51(1):8–19
Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, Wang PS, Wells KB, Zaslavsky AM (2005) Prevalence and treatment of mental disorders, 1990–2003. N Engl J Med 352:2515–2523
Kiloh LG, Andrews G, Neilson M (1988) The long-term outcome of depressive illness. Br J Psych 153:752–757
Kleining G, Moore H (1968) Soziale Selbsteinstufung (SSE). Ein Instrument zur Messung sozialer Schichten. Köln Z Soziol Sozialpsychol 20:502–552
Klerman GL, Weissman MM (1989) Increasing rates of depression. JAMA 15(261):2229–2235
Lee AS, Murray RM (1988) The long-term outcome of Maudsley depressives. Br J Psych 153:741–751
Lee AS (2003) Better outcomes for depressive disorders? Psychol Med 33:769–774
Lehtinen V, Lindholm T, Veijola J, Vaisanen E, Puukka P (1991) Stability of prevalences of mental disorders in a normal population cohort followed for 16 years. Soc Psychiatry Psychiatr Epidemiol 26(1):40–46
Lewinsohn PM, Rohde P, Seely JR, Fischer SA (1993) Age-cohort changes in the lifetime occurrence of depression and orther mental disorders. J Abnorm Psychol 102:110–120
Mattison C, Bogren M, Horstmann V, Munk-Jörgensen P, Nettelbladt P (2007) The long-term course of depressive disorders in the Lundby study. Psychol Med 37:883–891
Merikangas KR, Zhang H, Avenevoli S, Acharyya S, Neuenschwander M, Angst J (2003) Longitudinal trajectories of depression and anxiety in a prospective community study. Arch Gen Psychiatry 60:993–1000
Murphy JM (1980) Continuities in community-based psychiatric epidemiology. Arch Gen Psychiatry 37(11):1215–1223
Murphy JM, Monson RR, Olivier DC, Sobol AM, Leighton AH (1987) Affective disorders and mortality. A general population study. Arch Gen Psychiatry 44(5):473–480
Murphy JM (1990) Depression in the community: findings from the Stirling County study. Can J Psychiatry 35(5):390–396
Murphy JM, Olivier DC, Monson RR, Sobol AM, Federman EB, Leighton AH (1991) Depression and anxiety in relation to social status. A prospective epidemiologic study. Arch Gen Psychiatry 48(3):223–229
Murphy JM, Monson RR, Olivier DC, Zahner GE, Sobol AM, Leighton AH (1992) Relations over time between psychiatric and somatic disorders: the Stirling County study. Am J Epidemiol 136(1):95–105
Murphy JM, Laird NM, Monson RR, Sobol AM, Leighton AH (2000) A 40-year perspective on the prevalence of depression from the Stirling County study. Arch Gen Psychiatry 57:209–215
Murphy JM, Horton NJ, Laird NM, Monson RR, Sobol AM, Leighton AH (2004) Anxiety and depression: a 40-year perspective on relationships regarding prevalence, distribution, and comorbidity. Acta Psychiatr Scand 109:355–375
Nettelbladt P, Bogren M, Mattison C, ÖjesjÖ L, Hagnell O, Hofvendahl E, Toraker P, Phugra D (2005) Does it make sense to do repeated surveys? The Lundby Study, 1947–1997. Acta Psychiatr Scand 111:444–452
Ormel J, Vonkorff M, Ustun TB, PINI S, Korten A, Oldehinkel T (1994) Common mental disorders and disability across cultures. Results from the WHO collaborative study on psychological problems in general health care. JAMA 272(22):1741–1748
Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablensky A, Pickens R, Regier DA, Sartorius N, Towle LH (1989) The composite international diagnostic interview: an epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45:1069–1077
Rorsman B, Hagnell O, Lanke J (1982) Mortality in the Lundby study. Natural death in different forms of mental disorder in a total population investigated during a 25-year period. Neuropsychobiology 8(4):188–197
Rothman KJ, Greenland S (1998) Modern epidemiology. 2nd edn. Lippincott-Raven Publishers, Philadelphia
Simon GE, VonKorff M (1992) Reevaluation of secular trends in depression rates. Am J Epidemiol 135:1411–1422
Solomon DA, Keller MB, Leon AC, Mueller TI, Lavori PW, Shea MT, Coryell W, Warshaw M, Turvey C, Maser JD, Endicott J (2000) Multiple recurrences of major depressive disorder. Am J Psychiatry 157:229–233
Spitzer RL, Williams JBW, Gibbon M (1985) Instructional Manual for the Structured Clinical Interview for DSM-III-R (SCID, 7/1/1985 Revision). Biometrics Research Department, New York State Psychiatric Institute, 722 West, 168th Street, New York, 10032. Deutsche Bearbeitung: Wittchen HU, Zaudig M, Schramm E, Sprengler P, Mombaur W, Klug J, Horn R “Strukturiertes Klinisches Interview für DSM-III-R” (SKID). Interviewheft und Manual, Beltz Verlag, Weinheim
Srole L (1975) Measurement and classification in sociopsychiatric epidemiology: Midtown Manhattan study (1954) and Midtown Manhattan restudy (1974). J Health Soc Behav 16:347–364
SPSS for Windows (2004) Release 13. SPSS Inc., Chicago
Tsuang MT, Woolson RF (1977) Mortality in patients with schizophrenia, mania, depression and surgical conditions. A comparison with general population mortality. Br J Psychiatry 130:162–166
Van Weel-Baumgarten EM, Schers HJ, Van den Bosch WJ, Van den Hoogen HJ, Zitman FG (2000) Long-term follow-up of depression among patients in the community and in family practice settings: a systematic review. J Family Practice 49:1113–1120
Von Zerssen D, Koeller DM (1976) Die Beschwerdenliste (BL). Beltz Verlag, Weinheim
Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, Berry S, Greenfield S, Ware J (1989) The functioning and well-being of depressed patients: results from the Medical outcomes study. JAMA 262:914–919
Wells KB, Burnam MA, Rogers W, Hays R, Camp P (1992) The course of depression in adult outpatients. Results from the medical outcomes study. Arch Gen Psych 49:788–794
Wittchen HU, Perkonigg A (1996) Epidemiologie psychischer Störungen. In: Ehlers A, Hahlweg K (eds) Enzyklopädie der Psychologie. Grundlagen der Klinischen Psychologie, Göttingen
Wittchen HU, Pfister H (1997) Diagnostisches Expertensystem für Psychische Störungen DIA-X. Swets Test Services. Frankfurt
Wittchen HU, Lieb R, Pfister H, Schuster P (2000) The waxing and waning of mental disorders: evaluating the stability of syndromes of mental disorders in the population. Compr Psychiatry (Suppl 1) 41(2):122–132
World Health Organization (2000) World health organization: disability assessment schedule WHODAS II Phase 2 field trials. Health services research. World Health Organization, Geneva, pp 678–687
Acknowledgments
This research was funded by the Deutsche Forschungsgemeinschaft, Bonn, grant number Fi 333/4-1. We especially thank Dipl.-Psych. Eva Bolz, Dipl.-Psych. Helen Castellanos, Dipl.-Psych. Andrea Dusold, Dipl.-Psych. Andreas Hampel, Dr. Gabriele Kohlböck, Dipl.-Psych. Birgit Schaider, Dipl.-Psych. Nicole Sevignani and Dipl.-Psych. Nadia Sosnowsky for their sensitive way of conducting interviews with the subjects, and Susanne Hedlund (Ph.D.) for her support in formulating this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fichter, M.M., Kohlboeck, G. & Quadflieg, N. The Upper Bavarian longitudinal community study 1975–2004. 2. Long-term course and outcome of depression. Eur Arch Psychiatry Clin Neurosc 258, 476–488 (2008). https://doi.org/10.1007/s00406-008-0821-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00406-008-0821-z