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Abstract: Background: Literature about expectations and management of depression within community samples reflects attitudes of people who have generally not received treatment. We examined the factors influencing treatment expectations and psychiatrists'' treatment recommendations for patients referred to a mood disorders unit with identified episodes of major depression. Methods: Prior to attending a mood disorders unit, 182 men and women who met DSM-III-R or DSM-IV criteria for current major depression provided data on sociodemographic details, history of medical and psychiatric illness and expectations of treatment. Psychiatrists'' treatment recommendations to the referring clinician were assessed to determine whether the patients'' initial expectations were met. Results: Data analyses revealed three factors relating to patients'' expectations: ‘enhanced coping’, ‘providing fresh ideas for the referring doctor’ and ‘providing fresh ideas to self’. Patients'' expectations were influenced by sociodemographic and illness-related characteristics. In particular, young female patients typically expected to receive strategies to enhance coping, while those with lifetime anxiety expected less active involvement on their part. Some clinicians'' recommendations were dependent upon depression type and patient factors. Women and those with a history of anxiety disorders received more education and recommendations for relationship counselling and support groups. Limitations: The study design did not allow determination of the impact of patients'' expectations on the psychiatrists'' recommendations. Conclusions: Individual and illness characteristics are important predictors of treatment expectations prior to specialist care. It appears that doctors take these factors into account with implications for patients'' satisfaction with the type of care recommended. [Copyright &y& Elsevier]

Background: Recent studies have reignited debate concerning the relationship between stressful life events and depressive subtypes, particularly in relation to first versus subsequent episodes. Aims: To investigate the relationship between stressful life events and variably defined melancholic/non-melancholic depressive subtypes, and the import of such life events to first compared with subsequent episodes across those subtypes. Method: Acute and chronic stressful life events were rated in 270 patients with DSM-IV Major Depressive episodes who were allocated to melancholic and non-melancholic groups separately as defined by DSM-III-R, DSM-IV, the Newcastle criteria and the CORE system. Results: Severe stressful life events (both acute and chronic)—as defined by DSM-III-R axis IV—were more likely to occur prior to first rather than subsequent episodes, particularly for those with non-melancholic depression. Limitations: Dependence or independence of life events was not assessed. Genetic vulnerability to depression was not determined. Life events in first and subsequent depressive episodes were compared cross-sectionally between groups, not prospectively in the same cohort of patients. There were no differences in the number of severe life events—as defined by clinician consensus—between the first and subsequent episodes. Conclusions: These findings are consistent with other studies in suggesting an enhanced sensitisation of depressed patients to subsequent episodes of depression, but suggest that any such phenomenon is specific to non-melancholic depression, in comparison to one key previous study. [Copyright &y& Elsevier]