Elsevier

General Hospital Psychiatry

Volume 28, Issue 3, May–June 2006, Pages 205-212
General Hospital Psychiatry

Psychiatry and Primary Care
Watchful waiting for minor depression in primary care: remission rates and predictors of improvement

https://doi.org/10.1016/j.genhosppsych.2006.02.008Get rights and content

Abstract

Objectives

The objectives of this study were to determine remission rates and predictors of improvement for minor depression following a 1-month watchful waiting period in primary care and to describe the watchful waiting processes.

Methods

Prior to randomization into a clinical trial for minor depression, 111 participants were entered into a 1-month watchful waiting period. Depression severity and predictors of improvement were measured at the start of watchful waiting. At the end of watchful waiting, remission rates were calculated and predictor variables were analyzed for their contribution toward predicting improvement.

Results

Remission rates were low, ranging from 9% to 13%, depending on the measure. Avoidant coping style and frequency of engaging in active pleasant events at baseline accounted for the majority of change in depression. During watchful waiting, about one fifth of the sample (21%) had at least one contact with their physician and 27% reported using self-initiated treatments.

Conclusions

There is a low likelihood of spontaneous remission for treatment-seeking samples with minor depression in primary care. An avoidant coping style seriously interferes with remission, and engaging in regular active pleasant events confers an advantage. Feasible interventions for primary care that promote activity and decrease avoidant coping styles may improve outcomes. These findings may not generalize to community and non-treatment-seeking samples.

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.

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