The British Journal of Psychiatry (2010) 196: 13-17. doi: 10.1192/bjp.bp.109.067116
© 2010 The Royal College of Psychiatrists
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Comparison of risk factors for the onset and maintenance of depression

Christian Bottomley, PhD

Department of Primary Care and Population Sciences, University College London, UK

Irwin Nazareth, MBBS, PhD

Department of Primary Care and Population Health, University College London Medical School and Medical Research Council General Practice Research Framework, UK

Francisco Torres-González, MD, PhD

Department of Psychiatry, University of Granada, Spain

Igor Svab, MD, PhD

Department of Family Medicine, University of Ljubljana, Slovenia

Heidi-Ingrid Maaroos, MD, PhD

Faculty of Medicine, University of Tartu, Estonia

Mirjam I. Geerlings, PhD

University Medical Center, Utrecht, The Netherlands

Miguel Xavier, MD, PhD

Faculdade Ciências Médicas, University of Lisbon, Portugal

Sandra Saldivia, PhD

Departamento de Psiquiatraía y Salud Mental, Universidad de Concepción

Michael King, MD, PhD

Department of Mental Health Sciences, University College London, UK.

Correspondence: Correspondence: Christian Bottomley, Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Email: christian.bottomley{at}lshtm.ac.uk

Declaration of interest

None.

Background

Factors associated with depression are usually identified from cross-sectional studies.

Aims

We explore the relative roles of onset and recovery in determining these associations.

Method

Hazard ratios for onset and recovery were estimated for 39 risk factors from a cohort study of 10 045 general practice attendees whose depression status was assessed at baseline, 6 and 12 months.

Results

Risk factors have a stronger relative effect on the rate of onset than recovery. The strongest risk factors for both onset and maintenance of depression tend to be time-dependent. With the exception of female gender the strength of a risk factor’s effect on onset is highly predictive of its impact on recovery.

Conclusions

Preventive measures will achieve a greater reduction in the prevalence of depression than measures designed to eliminate risk factors post onset. The strength of time-dependent risk factors suggests that it is more productive to focus on proximal rather than distal factors.


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