• Lilian Salvo, Sandra Saldivia, Carlos Parra, Román Rodríguez, Manuel Cifuentes, Paola Acevedo, Marcela Díaz, Mitza Ormazabal, Ivonne Guerra, Nicol Navarrete, Verónica Bravo, and Andrea Castro.
• Programa Doctorado en Salud Mental, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile.
• Rev Med Chil. 2017 Mar 1; 145 (3): 335-343.

BackgroundDepression is considered the second leading cause of disability worldwide.AimTo describe the clinical characteristics and the evolution of major depressive disorder (MDD) in secondary care. To evaluate the association between socio-demographic and clinic variables with the first or recurrent major depressive events (MDE).Material And MethodsClinical features, treatment, remission and duration of MDE were evaluated during a follow up lasting 12 months in 112 participants aged 44 ± 15 years (79% women). Patients were assessed as outpatients every three months at three psychiatric care centers of Chile. Clinical interviews were carried out using DSM-IV diagnostic criteria checklists and the Hamilton Depression Scale was applied.ResultsMost patients were referred from primary care. The mean time lapse for referral to the secondary level was 10.8 months. Most patients had episodes that were recurrent, severe, with a high rate of psychosis, with suicide attempts and melancholic features and with psychiatric and medical comorbidities. Remission rate was 27.5%. In only 16 % of patients, the episode lasted six months or less. The group with recurrent episodes had different age, sex and clinical features.ConclusionsMDD treated at the secondary care level is severe and its symptoms are intense. The time lapse prior to referral was prolonged. Primary care management and referral of these patients should be studied more closely.

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