Analysis of phenotype conversion and its influencing factors in patients with first-episode depression: Based on a 7-year follow-up
Journal Title: Chinese Journal of Nervous and Mental Diseases - Year 2025, Vol 51, Issue 1
Abstract
[Objective] To understand phenotype conversion in patients with first-episode depression over a 7-year period, to explore the longitudinal disease characteristics and functional outcomes of transitions and non-transitions, and to further analyse the relevant factors affecting transitions. [Methods] A total of 346 patients with Hamilton depression scale-17 (HAMD-17) score≥18, aged 18-60 years and a single episode of major depressive disorder were included in the study. They were follow-up for 7 years to assess their natural history including demographic data, disease characteristics, whether transitions to manic occurred, treatment status. At the end of the 7-year follow-up, treatment emergent symptom scale (TESS), medication adherence rating scale (MARS), and global assessment function (GAF) were used to evaluate adverse reactions, compliance to medication, and patient’s overall functional level. Patients were divided into two groups based on the occurrence of mania or hypomania episodes during the 7-year period: the conversion group (those who developed episodes) and the non-conversion group (those who did not). [Results] A total of 138 patients were followed up for 7 years, including 54 patients (39.1%) in the conversion group and 84 patients (60.9%) in the non-conversion group. When the first episode was enrolled at baseline, the age of first episode was earlier in the conversion group than in the non-conversion group[ (27.63±9.63) years vs. (41.20±11.92) years], and there were differences in marital status (unmarried 40.7% vs. 7.1%, first marriage 53.7% vs. 85.7%, remarriage 3.7% vs. 2.4%, separated/divorced 0.0% vs. 2.4%, widowed 1.9% vs. 2.4%). The proportion of patients with precipitating factors was lower in the conversion group (29.6% vs. 48.8%) and shorter duration of untreated psychosis (DUP) [60 (15, 90) d vs. 90 (30, 180) d]. The treatment method in the conversion group had lower only used antidepressant drugs (61.1% vs. 81.0%) and more antidepressant combined with mood stabilizers (31.5% vs. 16.7%) (all P<0.05). In the 7 years, total number of episodes in the conversion group was more than in the non-conversion group (4.33±1.21 vs. 2.70±1.25, P<0.05). By the end of 7 years, the GAF score was lower in conversion group than in the non-conversion group (66.57±8.22 vs. 69.21±7.20, P<0.05). Dichotomous unconditional logistic regression analyses revealed that age at first episode (OR=1.109, 95%CI: 1.058-1.161, P<0.001), DUP (d) (OR=1.005, 95%CI: 1.001-1.009, P=0.017), was an independent influencing factor on conversion over a 7-year period in patients with first-episode depressive disorders. [Conclusion] The rate of conversion over 7 years in patients with first-episode depressive disorder is 39.1% in the present cohort and converted patients had relatively earlier age of onset, more pre-onset without inducement, shorter DUP (d), more recurrence, higher the rate of combined treatment and worse overall functional outcome.
Authors and Affiliations
Wei CUI, Chao YU, Linyan WANG, Lihua SONG, Yunping LU, Yunshu. ZHANG
Keywords
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- EP ID EP762101
- DOI 10.3969/j.issn.1002-0152.2025.01.007
- Views 19
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