Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project

Objective: To identify baseline sociodemographic and clinical factors associated with a current chronic major depressive episode (MDE). Method: Outpatients with major depressive disorder enrolled in 41 US primary or psychiatric care sites were divided into two groups based on self-report of current episode length (< 24 or >= 24 months). Logistic regression models were used to identify factors associated with chronicity of current depressive episode. Results: About 21.2% of 1380 subjects were in current, chronic MDEs. Older age, less education, lower income, no private insurance, unemployment, greater general medical illness burden, lower physical quality of life, concurrent generalized anxiety disorder, fewer prior episodes, and history of prior suicide attempts were all associated with chronic episodes. Blacks, Hispanics, and patients receiving care in primary as opposed to psychiatric care settings exhibited greater chronicity. Conclusions: Chronic depressive episodes are common and are associated with greater illness burden, comorbidity, socioeconomic disadvantage, and racial/ethnic minority status.