Population-Based Study of First Onset and Chronicity in Major Depressive Disorder

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Abstract
Many individuals with depressive disorder do not seek treatment, and those who do presumably represent the most severe cases. For this reason, the natural history of depressive disorder is best studied using a population-based sample, in which individuals are selected from the general population without regard to treatment. This sample source avoids the Berkson bias.1 Many individuals with a depressive episode do not experience a recurrence, and those who do represent the more chronic and severe cases. For this reason, the natural history of depressive disorder is best studied through prospective follow-up of a sample of individuals experiencing first lifetime onsets—that is, from the first episode forward. This approach avoids the “clinician's illusion,”2 sometimes called Neyman bias. These 2 biases are both likely to exaggerate the chronicity of depression.