Background This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care. Methods We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted. Results Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3–4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3–4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions. Conclusions When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.

中文翻译：

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抑郁症“障碍特征”对抑郁症患者预后判断的贡献：个体患者数据荟萃分析

背景 本研究旨在调查初级保健中患有抑郁症的成年人与预后相关的一般因素，无论接受的治疗类型如何。方: 独联体-R)。进行了两阶段随机效应荟萃分析。结果十二（n= 6024) 的 13 项符合条件的研究 (n= 6175) 提供了个体患者数据。在 3-4 个月时，基线抑郁症状每增加一个标准差，抑郁症状就会有 31%（95%CI：25 至 37）的差异。四个附加因素：焦虑的持续时间；抑郁持续时间；合并恐慌症；和抗抑郁治疗史也与较差的预后独立相关。有证据表明，当这些因素结合起来时，预后的差异可能具有临床重要性。添加这些变量可将 3-4 个月抑郁症状解释的方差量从仅使用抑郁症状严重程度的 16% 提高到 27%。所有研究的偏倚风险（使用 QUIPS 评估）都很低，质量（使用 GRADE 评估）很高。敏感性分析没有改变我们的结论。结论 当成人寻求抑郁症治疗时，临床医生应常规评估焦虑持续时间、抑郁持续时间、共病惊恐障碍、抗抑郁治疗史以及抑郁症状严重程度。这可以为临床医生和患者提供有用和所需的信息，以阐明预后并帮助抑郁症的临床管理。