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Major depression and its correlates in primary care settings in six countries

9-month follow-up study

Federal University of the State of Rio Grande do Sul, Porto Alegre, Brazil

Gregory Simon, MPH

Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington, USA

Helen Herrman, BMedSc

University of Melbourne and St Vincent’s Mental Health Service, Melbourne, Australia

Donald Bushnell, MA and Mona Martin, MPA

Health Research Associates, Inc., Seattle

Donald Patrick, PhD

University of Washington, Seattle, Washington, USA

Correspondence: Dr Marcelo Pio de Almeida Fleck, Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos 2350 4° andar, 90035-003 – Porto Alegre – RS, Brazil. E-mail: mfleck.voy{at}zaz.com.br

Declaration of interest None. See Appendix for details of the LIDO Group funding.

Background Few published studies address depression outcomes in primary care from a cross-cultural perspective.

Aims To define baseline factors associated with 9-month clinical outcomes across six countries.

Method Adults meeting criteria for current major depression were recruited from primary care clinics in Australia, Brazil, Israel, Spain, Russia and the USA; 968 patients were assessed at the 9-month follow-up. Predictors of complete remission were examined using logistic regression with a hierarchical model.

Results Rates of complete remission in the six sites ranged from 25% to 48%. Logistic regression using pooled data showed that education, key life events and the Quality of Life Depression Scale score at baseline were the final predictors of complete remission, adjusting for centres, socio-demographic data, severity of depression, comorbidity and general quality of life. Variationin predictors across sites was not statistically significant.

Conclusions The two major findings of this study were the low proportion of people achieving complete remission at follow-up across the six sites, and that some baseline characteristics (education, Quality of Life Depression Scale score and key life events) are modest predictors of outcome in depression.

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