Patterns of persistence with pharmacological treatment among patients with current depressive episode and their impact on long-term outcome: a naturalistic study with 5-year follow-up

Figures & data

Table 1 Predictors of subsequent visit after the first treatment interruption

Clinical characteristics	UD (N=128)a			BD (N=165)a
	N (%)	P-value	OR (95% CI)	N (%)	P-value	OR (95% CI)
Female sex	87 (68.0)	0.228	1.671 (0.725–3.853)	106 (64.2)	0.454	1.276 (0.674–2.414)
Trigger factorb	59 (46.1)	0.663	0.838 (0.407–1.729)	49 (29.7)	0.677	0.866 (0.440–1.704)
Age at illness onset (mean±SD)	34.8±13.0	0.577	0.992 (0.964–1.021)	24.5±9.5	0.333	1.017 (0.983–1.053)
Age (mean±SD)	36.4±12.2	0.988	1.000 (0.970–1.031)	26.5±9.3	0.366	1.016 (0.981–1.053)
Hospitalization after the first visit	12 (9.4)	0.268	2.492 (0.496–12.536)	29 (17.6)	0.037	2.771 (1.063–7.222)f
Misdiagnosed	10 (7.8)	0.453	1.607 (0.466–5.545)	76 (46.1)	<0.01	3.697 (1.148–7.434)
Duration of MDE (month)	11.2±13.4	0.407	0.992 (0.973–1.011)	7.7±19.8	0.513	1.009 (0.982–1.036)
Risk of suicidec		0.014	1.655 (1.107–2.476)		0.135	0.835 (0.659–1.058)
0	14 (10.9)			18 (10.9)
1	24 (18.8)			23 (13.9)
2	61 (47.7)			77 (44.8)
3	18 (14.1)			22 (12.8)
4	8 (6.3)			9 (5.2)
5	3 (2.3)			16 (9.3)
Season of onset
Spring	62 (48.8)	0.658	1.00 (ref)	80 (48.8)	0.116	1.0 (ref)
Summer	34 (26.6)	0.459	0.611 (0.166–2.250)	37 (22.4)	0.140	0.510 (0.208–1.247)
Autumn	18 (14.1)	0.744	0.792 (0.195–3.124)	18 (10.9)	0.372	0.629 (0.227–1.743)
Winter	14 (10.9)	0.793	1.250 (0.236–6.633)	30 (18.2)	0.308	2.143 (0.495–9.274)
Family history of mental disorderd	25 (19.5)	0.076	2.476 (0.910–6.735)	42 (25.5)	0.747	0.890 (0.437–1.811)
Comorbidity of anxiety disordere	35 (27.4)	0.002	4.619 (1.745–12.224)	35 (21.2)	0.089	2.058 (0.897–4.724)
Comorbidity of substance abuse	4 (3.1)	0.660	0.639 (0.087–4.695)	181 (10.9)	0.576	0.755 (0.282–2.023)
Comorbidity of physical illness	11 (8.6)	0.103	0.343 (0.095–1.241)	19 (11.5)	0.723	0.839 (0.319–2.209)
Psychotic features	7 (5.5)	0.180	4.355 (0.507–37.442)	34 (20.6)	0.919	1.041 (0.478–2.270)
Somatic symptom	48 (37.5)	0.040	2.286 (1.040–5.025)	42 (25.5)	0.402	1.371 (0.655–2.872)
Hypersomnia	6 (4.7)	0.262	3.478 (0.394–30.721)	35 (21.2)	0.403	1.389 (0.643–2.999)
History of spontaneous remission or switchf	13 (10.1)	0.483	1.558 (0.452–1.558)	79 (47.3)	0.031	0.503 (0.270–0.938)
TLP1 (month)	13.0±19.7	0.017	1.041 (1.007–1.075)	12.9±15.4	0.006	1.033 (1.009–1.058)
NV in the first episode of treatment	13.9±19.0	0.926	0.999 (0.981–1.018)	15.0±17.5	0.040	1.022 (1.001–1.043)

Notes:

a Patients involved in the statistics here included all the eligible participants who discontinued treatment at least once during the 5-year follow-up.

b At baseline, subjects were asked whether their current depressive episode was triggered by any life event. If the answer was “yes”, it meant that the trigger factor here was positive.

c Risk of suicide was leveled as 1) no suicidal ideation; 2) suicidal ideation but no suicidal plan; 3) suicidal plan but no suicidal attempt; 4) one suicidal attempt; 5) more than one suicidal attempt.

d Mental disorder here included psychotic disorder and mood disorder.

e Anxiety disorder here consisted of generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, phobia, somatization disorder.

f Switch means switching from depressive episode to hypomania episode. Values in bold represent significant results.

Abbreviations: UD, unipolar depression; BD, bipolar disorder; MDE, major depressive episode; TLP1, time to lack of persistence in the first episode of treatment; NV, number of visits.

Figure 1 Flowchart of this study.

Abbreviation: MDE, major depressive episode.

Table 2 Pattern of medication persistence in the first period of treatment

Medication persistence	UD N (%)	BD N (%)	Total N (%)
TLP (month)
0–3	60 (47.6)	84 (50.9)	144 (49.5)
3–6	17 (13.5)	26 (15.8)	43 (14.8)
6–9	18 (14.3)	14 (8.5)	32 (11.0)
9–12	4 (3.2)	12 (7.3)	16 (5.5)
12–60	27 (21.4)	29 (17.6)	56 (19.2)
Total	126 (100.0)	165 (100.0)	291 (100.0)
NV
1	28 (22.2)	31 (18.8)	59 (20.3)
2–5	25 (19.8)	48 (29.1)	73 (25.1)
–10	31 (24.6)	35 (21.2)	66 (22.7)
1–15	12 (9.5)	13 (7.9)	25 (8.6)
16–20	7 (5.6)	11 (6.7)	18 (6.2)
≥21	23 (18.3)	27 (16.4)	50 (17.2)
Total	126 (100.0)	165 (100.0)	291 (100.0)

Abbreviations: UD, unipolar depression; BD, bipolar disorder; TLP, time to lack of persistence; NV, number of visits.

Figure 2 TLP1 for all the participants.

Abbreviation: TLP1, time to lack of persistence in the first episode of treatment.

Figure 3 TLP2 for all the participants.

Abbreviation: TLP2, time to lack of persistence in the second episode of treatment.

Table 3 Comparison of TLP between the first and the second episode of treatment

TLP (month)	The first episode of treatment			The second episode of treatment			ra (P-value)
	UD N (%)	BD N (%)	Total N (%)	UD N (%)	BD N (%)	Total N (%)
0–12	41 (59.4)	45 (60.8)	86 (60.1)	23 (33.3)	26 (35.1)	34 (34.3)	0.681 (<0.001)
12–24	13 (18.8)	12 (16.2)	25 (17.5)	19 (27.5)	12 (16.2)	31 (21.7)
24–36	9 (13.0)	8 (10.8)	17 (11.9)	9 (13.0)	17 (23.0)	26 (18.2)
36–	6 (8.7)	9 (12.2)	15 (10.5)	18 (26.1)	19 (25.7)	37 (25.9)
Total	69 (100.0)	74 (100)	143 (100.0)	69 (100.0)	74 (100.0)	143 (100.0)

Notes:

a Association analysis was conducted between the first and the second episode of treatment based on the combined sample of UD and BD patients. Values in bold represent significant results.

Abbreviations: TLP, time to lack of persistence; UD, unipolar depression; BD, bipolar disorder.

Figure 4 Five-year outcome of UD patients.

Note: 1=full remission, 2=partial remission, 3=recurrence or relapse, 4=chronicity, 5=dead.
Abbreviation: UD, unipolar depression.

Figure 5 Five-year outcome of BD patients.

Note: 1=full remission, 2=partial remission, 3=recurrence or relapse, 4=chronicity, 5=dead.
Abbreviation: BD, bipolar disorder.

Table 4 Association of NTI with 5-year outcome

Group	Outcome	NTI					Total	χ^2 (P-value)
		0	1	2	3–5	>5
UD	Full remission	4 (3.8%)	12 (11.5%)	3 (2.9%)	2 (1.9%)	0 (0.0%)	21 (20.2%)	23.794
	Partial remission	12 (11.5%)	10 (9.6%)	14 (13.5%)	19 (18.3%)	7 (6.7%)	62 (59.6%)	(0.001)
	Othersa	1 (1.0%)	1 (1.0%)	7 (6.7%)	8 (7.7%)	4 (3.8%)	21 (20.2%)
	Total	17 (16.3%)	23 (22.1%)	24 (23.1%)	29 (27.9%)	11 (10.6%)	104 (100.0%)
BD	Full remission	2 (1.4%)	14 (9.9%)	7 (4.9%)	2 (1.4%)	0 (0.0%)	25 (17.6%)	21.917
	Partial remission	14 (9.9%)	19 (13.4%)	19 (13.4%)	19 (13.4%)	5 (3.5%)	76 (53.5%)	(0.003)
	Othersa	2 (1.4%)	10 (7.0%)	7 (4.9%)	14 (9.9%)	8 (5.6%)	41 (28.9%)
	Total	18 (12.7%)	43 (30.3%)	33 (23.2%)	35 (24.6%)	13 (9.2%)	142 (100.0%)
UD + BD	Full remission	6 (2.4%)	26 (10.6%)	10 (4.1%)	4 (1.6%)	0 (0.0%)	46 (18.7%)	44.850
	Partial remission	26 (10.6%)	29 (11.8%)	33 (13.4%)	38 (15.4%)	12 (4.9%)	138 (56.1%)	(3.9e–7)
	Othersa	3 (1.2%)	11 (4.5%)	14 (5.7%)	22 (8.9%)	12 (4.9%)	62 (25.2%)
	Total	35 (14.2%)	66 (26.8%)	57 (23.2%)	64 (26.0%)	24 (9.8%)	246 (100.0%)

Note:

a Including recurrence, chronically illness and death.

Abbreviations: NTI, number of treatment interruptions; UD, unipolar depression; BD, bipolar disorder.