On reducing the duration of untreated illness in unipolar depression

Factors characterizing access and latency to first pharmacological treatment in Italian patients with schizophrenia, mood, and anxiety spectrum disorders

Latency to first pharmacological treatment [duration of untreated illness (DUI)] in psychiatric disorders can be measured in years, with differences across diagnostic areas and relevant consequences in terms of socio-occupational functioning and outcome. Within the psychopathological onset of a specific disorder, many factors influence access and latency to first pharmacotherapy and the present study aimed to investigate such factors, through an ad-hoc developed questionnaire, in a sample of 538 patients with diagnoses of schizophrenia-spectrum disorder (SZ), mood disorder (MD), and anxiety disorder (AD). Patients with SZs showed earlier ages at onset, first diagnosis and treatment, as well as shorter DUI compared with other patients (43.17 months vs. 58.64 and 80.43 months in MD and AD; F=3.813, P=0.02). Patients with MD and AD reported more frequently onset-related stressful events, benzodiazepines as first treatment, and autonomous help seeking compared with patients with SZs. In terms of first therapist, psychiatrist referral accounted for 43.6% of the cases, progressively decreasing from SZ to MD and AD (57.6, 41.8, and 38.3%, respectively). The opposite phenomenon was observed for nonpsychiatrist clinician referrals, whereas psychologist referrals remained constant. The present findings confirm the presence of a relevant DUI in a large sample of Italian patients with different psychiatric disorders (5 years, on average), pointing out specific differences, in terms of treatment access and latency, between psychotic and affective patients. Such aspects are relevant for detection of at-risk patients and implement early intervention programs.

Duration of untreated illness and outcomes in unipolar depression: a systematic review and meta-analysis

BACKGROUND

To systematically review evidence of the effects of the duration of untreated depression on the clinical outcomes of patients suffering from Unipolar Major Depression.

METHODS

A systematic review and meta-analysis of the evidence of duration of untreated depression and the effect it has on clinical outcomes in Unipolar Major Depression. Data used to this purpose were obtained from a literature search of the MEDLINE, Psychoinfo and Embase databases. Comparable data extracted from studies were entered and analysed using Cochrane Collaboration's Review Manager software Version 5.2.

RESULTS

Ten studies were identified as meeting the inclusion criteria. Only three studies reported comparable data and were consequently used for the meta-analysis. Pooled data indicates the overall positive effect of shorter duration of untreated illness both in a patient's response to treatment (RR 1.70) and remission (RR 1.65). Other studies which were not included in the meta-analysis confirmed the importance of reducing delays in the treatment of depression in order to prevent the risk of worse outcomes and chronicity, in particular in patients presenting with a first episode of depression. Data regarding the association between the duration of untreated episode in recurrent depression and clinical outcomes are less evident.

LIMITATIONS

The heterogeneity of the selected studies was cause for limitations with regard to the carrying out of adequate meta-analysis.

CONCLUSIONS

There is evidence highlighting the importance of a reduced no-treatment interval for patients suffering Unipolar Depression. In particular, there is emphasis on the first episode of depression corresponding to the notion of reducing the duration of untreated illness.

Diagnosis delay in first episodes of major depression: a study of primary care patients in Spain

BACKGROUND

Diagnosis delay may negatively influence the clinical course of major depression; however, few studies have analysed the role of environmental factors on diagnosis delay. This study was aimed to identify personal and environmental factors related to a longer delay.

METHODS

A cross-sectional observational study with 3615 primary care patients with a first diagnosis of major depression was conducted. Diagnosis delay was defined as the time between onset of symptoms and diagnosis of major depression.

RESULTS

Mean of delay was 9.89 weeks. Lower years of education, triggering stressful life events before the current episode, history of previous undiagnosed depressive episodes and somatic comorbidity were related to longer delay. Health system variables, such as urban setting, public health care setting, younger doctors and female doctors were also related to a longer delay.

LIMITATIONS

Onset of first depressive symptoms was retrospectively collected. The cross-sectional design does not allow making inferences about the temporal ordering between predictors and outcomes.

CONCLUSIONS

Both personal and environmental variables were related to diagnosis delay. Identification of these factors helps to design early diagnosis programs to ultimate reduce the morbidity associated with major depression.