Background: To evaluate risk factors for the recurrence of serous macular detachment in untreated patients with central serous chorioretinopathy (CSC). Methods: Retrospective review of untreated CSC patients with a follow-up of ≧3 years. Patient demographics, visual outcome and risk factors for the recurrence of CSC were analyzed. Results: Seventy-three eyes of 73 patients were included, and the mean age was 44.6 years. At baseline, the mean logMAR best corrected visual acuity (BCVA) was 0.30. After a mean follow-up of 72 months, the mean final logMAR BCVA was 0.32. The difference between the final and baseline BCVAs was not statistically significant (p = 0.79). At the last follow-up, 9 (12.3%) eyes showed improved vision of ≧2 lines, and 12 (16.4%) showed a worsening of ≧2 lines. During follow-up, 38 (52.1%) patients experienced ≧1 episode of CSC recurrence. Multivariate Cox regression analysis showed that patients with a history of psychiatric illness (adjustment disorder and depression) were associated with an increased risk of CSC recurrence (hazard ratio = 3.5, p = 0.011). Conclusions: The long-term visual prognosis of CSC is fair without treatment, and a significant proportion of patients developed recurrence of CSC. A history of psychiatric illness is associated with an increased risk of CSC recurrence.