Publication

Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review

de Zwart, P. L., Jeronimus, B. F. & de Jonge, P., Oct-2019, In : Epidemiology and psychiatric sciences. 28, 5, p. 544-562 19 p.

Research output: Contribution to journalArticleAcademicpeer-review

AIMS: For the past quarter of a century, Frank et al.'s (1991) consensus-based definitions of major depressive disorder (MDD) episode, remission, recovery, relapse and recurrence have been the paramount driving forces for consistency in MDD research as well as in clinical practice. This study aims to review the evidence for the empirical validation of Frank et al.'s proposed concept definitions and to discuss evidence-based modifications.

METHODS: A literature search of Web of Science and PubMed from 1/1/1991 to 08/30/2017 identified all publications which referenced Frank et al.'s request for definition validation. Publications with data relevant for validation were included and checked for referencing other studies providing such data.

RESULTS: A total of 56 studies involving 39 315 subjects were included, mainly presenting data to validate the severity and duration thresholds for defining remission and recovery. Most studies indicated that the severity threshold for defining remission should decrease. Additionally, specific duration thresholds to separate remission from recovery did not add any predictive value to the notion that increased remission duration alleviates the risk of reoccurrence of depressive symptoms. Only limited data were available to validate the severity and duration criteria for defining a depressive episode.

CONCLUSIONS: Remission can best be defined as a less symptomatic state than previously assumed (Hamilton Rating Scale for Depression, 17-item version (HAMD-17) ⩽4 instead of ⩽7), without applying a duration criterion. Duration thresholds to separate remission from recovery are not meaningful. The minimal duration of depressive symptoms to define a depressive episode should be longer than 2 weeks, although further studies are required to recommend an exact duration threshold. These results are relevant for researchers and clinicians aiming to use evidence-based depression outcomes.

Original languageEnglish
Pages (from-to)544-562
Number of pages19
JournalEpidemiology and psychiatric sciences
Volume28
Issue number5
Early online date17-May-2018
Publication statusPublished - Oct-2019

    Keywords

  • Depression, evidence-based psychiatry, mood disorders unipolar, outcome studies, systematic reviews, MONTGOMERY-ASBERG DEPRESSION, RATING-SCALE, HAMILTON DEPRESSION, MAJOR DEPRESSION, DEFINE REMISSION, RESIDUAL SYMPTOMS, FOLLOW-UP, DISORDER, OUTPATIENTS, CRITERIA

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