Psychiatry and Primary CareWatchful waiting for minor depression in primary care: remission rates and predictors of improvement☆
Section snippets
Background
Acute depressive syndromes not meeting the criteria for major depression (i.e., minor depression) are among the most common types of depressive disorders [1], [2], [3], [4], [5] and are associated with significant morbidity [1], [2], [5], [6], [7]. In primary care settings, minor depression is more prevalent than major depression [7], [8]. At this time, there are mixed findings supporting whether to use antidepressants or psychotherapy for minor depression [9], [10], [11], [12], [13], [14], [15]
Objectives
We report on remission rates for minor depression and describe the characteristics of a 1-month watchful waiting period. We then analyze the hypothesized variables for their role in predicting depressive symptoms at the end of watchful waiting. We hypothesized that behavioral activation, social support and problem-focused coping, as measured at the start of watchful waiting, would be related to improvement in depressive symptoms at the end of watchful waiting. We also hypothesized that, as
Participants and procedures
The current study was derived from an ongoing randomized controlled trial of a brief counseling intervention for minor depression in primary care. Before randomization, the study included a 1-month watchful waiting period to eliminate participants who remit under this condition from the trial. Participants were recruited from two primary care practices associated with the Dartmouth-Hitchcock Medical Center (Lebanon, NH, USA). The institutional review board approved the study. A complete
Demographic and clinical characteristics
Ages ranged from 20 to 90 (mean=55, S.D.=15.2) years, with 36% of the patients being 60 years or older and 56% being female (Table 1). Half of the participants had lower than an undergraduate college degree (51%) and were employed full time (50%). Almost all were Caucasian (96%), reflecting the predominant racial/ethnic background for Northern New England, and 71% were married. The mean HAM-D score at baseline was 13.8 (S.D.=3.0), reflecting the mild to moderate level of depression severity for
Conclusions
Although not a randomized controlled trial of watchful waiting, to our knowledge, this is the first study to evaluate a watchful waiting period for minor depression in primary care. Remission rates were low, with only 9–13% of patients achieving remission after 4 weeks of watchful waiting. This is substantially lower than as suggested by community-based surveys. In part, this discrepancy may be due to the fact that participants had enrolled in a treatment trial. Unlike in an
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The preparation of this article was supported by NIMH Grant MH62322 to T.E.O.