Background: The outcome and impact of major depression in developing countries are not clear.
Aims: To describe the outcome of major depression and compare the disability and patterns of service use among different outcome groups.
Method: In a case cohort study, nested within a population-based survey of 68,000 participants using the Composite International Diagnostic Interview (CIDI), 300 participants were randomly selected from those with current major depression and 300 from those with no lifetime history. Participants were re-interviewed after 18-62 months to ascertain current diagnosis, psychological symptoms, disability and use of health services.
Results: Of participants with major depression at baseline 26% also met criteria for major depression at follow up. Mortality ratio standardised for age and gender was 3.55 (95% C11.97 to 6.39). All indices of measure of disability were significantly higher in the persistently depressed group compared with the completely recovered group. Participants who had recovered partially resembled participants with persistent depression. Two-thirds of those with persistent depression had not sought any help.
Conclusions: Major depression was associated with mortality and disability. Those with residual symptoms remained disabled. Help-seeking was unusual.