JAMA Psych: A Ten-Year Developmental Trajectory of Moderate to Major Depression Wenwei Yan, Department of Psychiatry, Taicang Third People’s Hospital In this large sample (11,640), more than three-quarters of patients with moderate to major depression were stable 2 years after diagnosis and almost did not need to be seen again; 3% of patients continued to receive professional treatment in outpatient emergency or inpatient units multiple times in the 10 years after diagnosis . Parental histories of depression, anxiety, and schizophrenia were each associated with depression developmental outcomes in their children, suggesting differences in the underlying genetic mechanisms of depression. Evidence suggests that long-term developmental outcomes vary among patients with moderate or major depressive disorder (MDD), as shown in a large study published online March 2 in JAMA Psychiatry (IF 12.008). In a large study published online in the March 2 issue of JAMA Psychiatry (IF 12.008), researchers from Denmark and the United States clarified the 10-year developmental outcomes of MDD by using data from the Danish Psychiatric Center Research Registry (DPCRR). As a national registry, the DPCRR records all outpatient emergency and inpatient cases in Danish psychiatric hospitals since 1995. A total of 11,640 patients born in Denmark after 1955 and first diagnosed with MDD between 1995 and 2002 were included in this analysis, 64.4% of whom were female, and the age at first presentation was 18-48 years. Subjects were followed up for 10 years since first diagnosis. In determining the progressive outcomes of these patients, the investigators explored the impact of multiple variables, including gender, first MDD episode and clinic characteristics (e.g., age, severity, hospitalization, suicidal self-injury) and psychiatric diagnoses (e.g., depression, bipolar disorder, schizophrenia spectrum disorder, substance abuse, anxiety, or somatoform disorder). Outcomes were analyzed primarily by the number of outpatient emergency department visits or hospital admissions with MDD as the primary diagnosis during the follow-up period (within the past year). Psychiatric visits at 10 years of follow-up (Musliner KL, et al. 2016)▲ There were four outcomes for more than 10,000 patients (shown above): 1. Short-term visit type (Class 1): low likelihood of visit within 2 years of follow-up and low likelihood of visit after 2 years; 77.0% of patients in this category. 2. Extended initial visit type (Class 2): high likelihood of visit within 2 years of follow-up and acute visit within 5 years. The likelihood of a visit in the first 5 years of follow-up declined gradually, but the likelihood of a visit in the second 5 years increased to moderate; 7.1% of patients in this category. 4. 3.1%. ▲ Female (OR, 1.82-2.22), hospitalization (1.40-1.50) and first episode severity (moderate, 1.61-1.84; severe, 1.93-2.23; psychotic, 2.73-3.07) were all associated with poorer developmental outcomes. In other words, male patients, who were not severe enough to be hospitalized, had better prognostic outcomes, i.e., types 1 and 2 above, while female patients with more severe disease tended to be types 3 and 4 above. ▲ Parental anxiety (OR, 1.34 [95% CI, 1.10-1.63]) and depression (OR, 1.63 [95% CI, 1.28-2.09]) were significantly associated with Class 2 and Class 3, respectively, and schizophrenia was significantly associated with Class 4 (OR, 2.55-3.04). Based on these results, the investigators noted that the majority of patients with moderate-to-severe MDD in this sample were no longer seen after 2 years, but a small number of patients were in and out of the hospital for up to 10 years and continued to receive professional treatment. Different family histories of mental disorders influence the course of MDD and may reflect differences in the underlying genetic mechanisms of depression. Comment by Dr. Wen-Wei Yen: This study is large, with a large number of follow-ups and relatively reliable outcomes, and should be trusted by professional doctors and patients.