Follow-up of the first depressive episode: prevalence and factors associated with the development of recurrent depressive disorder and bipolar affective disorder

The high prevalence and tendency to relapse associated with depressive disorders highlight the need to investigate the long-term outcomes of a first depressive episode.

Objective: to determine the prevalence and identify the factors associated with the development of recurrent depressive disorder (RDD) and bipolar affective disorder (BAD) following inpatient treatment for a first depressive episode.

Material and methods. A retrospective cohort study was conducted involving 237 patients hospitalised with a first depressive episode between 2013 and 2017. The follow-up period was up to 12 years.

Results. RDD developed in 20.3% of patients, and BAD in 12.2%. Factors associated with the development of RDD included older age (median 51 years; p=0.034), chronic psychological trauma (p=0.016), episode duration of more than 60 days prior to hospitalisation (p<0.001) and a family history of mental illness (p<0.001). Factors associated with the development of BAD were younger age (median – 35 years; p=0.043), male gender (p<0.001), a disharmonic premorbid personality (p<0.001), a history of mood swings (p=0.002), alcohol abuse (p<0.001) and a family history of mental illness (p<0.001). An early (within 6 months) exacerbation was associated with a short first hospital stay (median – 15 days; p<0.001) and irregular adherence to maintenance therapy (p<0.001).

Conclusion. One in three patients develops chronic affective disorder following their first depressive episode. The identified prognostic markers make it possible to identify high-risk groups for RDD and BAD as early as the first hospitalisation, thereby enabling the personalisation of treatment strategies.

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