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Articles by I Nazareth
Total Records ( 2 ) for I Nazareth
  N. P Zuithoff , Y Vergouwe , M King , I Nazareth , E Hak , K. G Moons and M. I Geerlings

Background. Major depressive disorder often remains unrecognized in primary care.

Objective. Development of a clinical prediction rule using easily obtainable predictors for major depressive disorder in primary care patients.

Methods. A total of 1046 subjects, aged 18–65 years, were included from seven large general practices in the center of The Netherlands. All subjects were recruited in the general practice waiting room, irrespective of their presenting complaint. Major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Text Revision edition criteria was assessed with the Composite International Diagnostic Interview. Candidate predictors were gender, age, educational level, being single, number of presented complaints, presence of non-somatic complaints, whether a diagnosis was assigned, consultation rate in past 12 months, presentation of depressive complaints or prescription of antidepressants in past 12 months, number of life events in past 6 months and any history of depression.

Results. The first multivariable logistic regression model including only predictors that require no confronting depression-related questions had a reasonable degree of discrimination (area under the receiver operating characteristic curve or concordance-statistic (c-statistic) = 0.71; 95% Confidence Interval (CI): 0.67–0.76). Addition of three simple though more depression-related predictors, number of life events and history of depression, significantly increased the c-statistic to 0.80 (95% CI: 0.76–0.83). After transforming this second model to an easily to use risk score, the lowest risk category (sum score < 5) showed a 1% risk of depression, which increased to 49% in the highest category (sum score ≥ 30).

Conclusion. A clinical prediction rule allows GPs to identify patients—irrespective of their complaints—in whom diagnostic workup for major depressive disorder is indicated.

  C Bottomley , I Nazareth , F Torres Gonzalez , I Svab , H. I Maaroos , M. I Geerlings , M Xavier , S Saldivia and M. King


Factors associated with depression are usually identified from cross-sectional studies.


We explore the relative roles of onset and recovery in determining these associations.


Hazard ratios for onset and recovery were estimated for 39 risk factors from a cohort study of 10 045 general practice attendees whose depression status was assessed at baseline, 6 and 12 months.


Risk factors have a stronger relative effect on the rate of onset than recovery. The strongest risk factors for both onset and maintenance of depression tend to be time-dependent. With the exception of female gender the strength of a risk factor’s effect on onset is highly predictive of its impact on recovery.


Preventive measures will achieve a greater reduction in the prevalence of depression than measures designed to eliminate risk factors post onset. The strength of time-dependent risk factors suggests that it is more productive to focus on proximal rather than distal factors.

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