Progression from unipolar depression to schizophrenia

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OBJECTIVE: To examine progression from unipolar depression (UD) to schizophrenia and to identify groups of UD patients at elevated risk for progression.

METHOD: Historical prospective cohort study using data from Danish national registers. The sample included 71 932 individuals who received a diagnosis of UD in Denmark between January 1, 1995, and May 31, 2013. Analyses were conducted using Kaplan-Meier estimates and Cox regressions.

RESULTS: The 18.5-year cumulative incidence of schizophrenia was 5.5% in women and 8.4% in men. The strongest predictors of progression included younger age (adjusted hazard ratio (AHR) for individuals 18-24 vs. 40+ = 7.42, 95% confidence interval = [6.29, 8.74]), psychotic symptoms at index UD diagnosis (AHR = 3.70 [3.18, 4.31]), previous disorder with psychotic features (AHR = 3.71 [3.31, 4.16]), and previous illicit substance use disorder (AHR = 1.66 [1.40, 1.97]). Groups of UD patients with different combinations of risk factors had elevated risk for progression, with 10-year cumulative incidences ranging from 9% to 62%. To conclude, at the time of UD diagnosis, the strongest risk factors for progression to schizophrenia include male sex, younger age, past/current psychotic symptoms, and illicit substance use disorders. These clinical predictors may aid in targeting monitoring for schizophrenia among patients with UD.

Original languageEnglish
JournalActa Psychiatrica Scandinavica
Volume135
Issue1
Pages (from-to)42-50
Number of pages9
ISSN0001-690X
DOIs
Publication statusPublished - 1 Jan 2017

    Research areas

  • Adolescent, Adult, Aged, Denmark/epidemiology, Depressive Disorder, Major/psychology, Disease Progression, Female, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Registries, Risk Factors, Schizophrenia/epidemiology, Young Adult

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