The focus of the original paper is to find important risk factors from multiple perspectives related to the persistent course of chronic major depression, including socio-demographic dimension, economic dimension, insurance, family and developmental risks, previous physical, mental and emotional conditions, treatment-seeking patterns, as well as the nature of chronic MDD conditions.

However, a second look of the results, it can be found that insurance status played a major role compared to other socio-economic factors. Specially, public insurance beneficiaries are more likely to have a persistent course of chronic MDD, compared to private insurance beneficiaries. In addition, in terms of treatment-seeking patterns, patients who had persistent type of chronic MDD increased odds of seeking treatments. Even though, these patients still persistently developed depressive disorder. So, it essentially comes a question. Exactly, what type of treatment can be effective to these patients with persistent chronic MDD?