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Lookup NU author(s): Dr Nick MeaderORCiD
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ. BACKGROUND: Relapse of depression is common and contributes to the overall associated morbidity and burden. We lack evidence-based tools to estimate an individual's risk of relapse after treatment in primary care, which may help us more effectively target relapse prevention. OBJECTIVE: The objective was to develop and validate a prognostic model to predict risk of relapse of depression in primary care. METHODS: Multilevel logistic regression models were developed, using individual participant data from seven primary care-based studies (n=1244), to predict relapse of depression. The model was internally validated using bootstrapping, and generalisability was explored using internal-external cross-validation. FINDINGS: Residual depressive symptoms (OR: 1.13 (95% CI: 1.07 to 1.20), p<0.001) and baseline depression severity (OR: 1.07 (1.04 to 1.11), p<0.001) were associated with relapse. The validated model had low discrimination (C-statistic 0.60 (0.55-0.65)) and miscalibration concerns (calibration slope 0.81 (0.31-1.31)). On secondary analysis, being in a relationship was associated with reduced risk of relapse (OR: 0.43 (0.28-0.67), p<0.001); this remained statistically significant after correction for multiple significance testing. CONCLUSIONS: We could not predict risk of depression relapse with sufficient accuracy in primary care data, using routinely recorded measures. Relationship status warrants further research to explore its role as a prognostic factor for relapse. CLINICAL IMPLICATIONS: Until we can accurately stratify patients according to risk of relapse, a universal approach to relapse prevention may be most beneficial, either during acute-phase treatment or post remission. Where possible, this could be guided by the presence or absence of known prognostic factors (eg, residual depressive symptoms) and targeted towards these. TRIAL REGISTRATION NUMBER: NCT04666662.
Author(s): Moriarty AS, Paton LW, Snell KIE, Archer L, Riley RD, Buckman JEJ, Chew Graham CA, Gilbody S, Ali S, Pilling S, Meader N, Phillips B, Coventry PA, Delgadillo J, Richards DA, Salisbury C, McMillan D
Publication type: Article
Publication status: Published
Journal: BMJ Mental Health
Year: 2024
Volume: 27
Issue: 1
Online publication date: 28/10/2024
Acceptance date: 09/10/2024
Date deposited: 11/11/2024
ISSN (electronic): 2755-9734
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/bmjment-2024-301226
DOI: 10.1136/bmjment-2024-301226
Data Access Statement: Data are available on reasonable request.
PubMed id: 39467616
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