Systematic Use of Patient-Rated Depression Severity Monitoring: Is It Helpful and Feasible in Clinical Psychiatry?

American Psychiatric Institutefor Research and Education, Arlington, VA 22209, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 11/2008; 59(10):1148-54. DOI: 10.1176/
Source: PubMed


The gap between evidence-based treatments and routine care has been well established. Findings from the Sequenced Treatments Alternatives to Relieve Depression (STAR*D) emphasized the importance of measurement-based care for the treatment of depression as a key ingredient for achieving response and remission; yet measurement-based care approaches are not commonly used in clinical practice.
The Nine-Item Patient Health Questionnaire (PHQ-9) for monitoring depression severity was introduced in 19 diverse psychiatric practices. During the one-year course of the project the helpfulness and feasibility of implementation of PHQ-9 in these psychiatric practices were studied. The project was modeled after the Institute for Healthcare Improvement Breakthrough Series. Two of the 19 practices dropped out during the course of the project.
By the conclusion of the study, all remaining 17 practices had adopted PHQ-9 as a routine part of depression care in their practice. On the basis of responses from 17 psychiatrists from those practices, PHQ-9 scores influenced clinical decision making for 93% of 6,096 patient contacts. With the additional information gained from the PHQ-9 score, one or more treatment changes occurred during 40% of these clinical contacts. Changing the dosage of antidepressant medication and adding another medication were the most common treatment changes recorded by psychiatrists, followed by starting or increasing psychotherapy and by switching or initiating antidepressants. In 3% of the patient contacts, using the PHQ-9 led to additional suicide risk assessment.
The study findings suggest that adopting measurement-based care, such as using the PHQ-9, is achievable, even in practices with limited resources.

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    • "Assessing treatment progress and outcome in acute treatment settings (e.g., inpatient, residential , or partial hospitals) is just as critical as other settings and warrants its own empirically-based evidence given the unique characteristics of these settings (e.g., very limited time to provide treatment in a population with high levels of symptom severity, comorbidity, functional impairment, and suicide risk). Although the clinical benefits of using evidence based assessments to monitor treatment outcome are clear (e.g., Duffy et al. 2008; Slade et al. 2006), they remain underutilized in psychiatric settings (Weiss et al. 2009; Zimmerman and McGlinchey 2008; Gilbody et al. 2002). This is in part due to a lack of recognition of the clinical benefits, as well as practical barriers such as time (Zimmerman and McGlinchey 2008). "
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    ABSTRACT: The CES-D-10, QIDS-SR, and DASS-21-DEP are brief self-report instruments for depression that have demonstrated strong psychometric properties in clinical and community samples. However, it is unclear whether any of the three instruments is superior for assessing depression and treatment response in an acute, diagnostically heterogeneous, treatment-seeking psychiatric population. The present study examined the relative psychometric properties of these instruments in order to inform selection of an optimal depression measure in 377 patients enrolled in a psychiatric partial hospital program. Results indicated that the three measures demonstrated good to excellent internal consistency and strong convergent validity. They also demonstrated fair to good diagnostic utility, although diagnostic cut-off scores were generally higher than in previous samples. The three measures also evidenced high sensitivity to change in depressive symptoms over treatment, with the QIDS-SR showing the strongest effect. The results of this study indicate that any of the three depression measures may satisfactorily assess depressive symptoms in an acute psychiatric population. Thus, selection of a specific assessment tool should be guided by the identified purpose of the assessment. In a partial hospital setting, the QIDS-SR may confer some advantages, such as correspondence with DSM criteria, greater sensitivity to change, and assessment of suicidality.
    Journal of Psychopathology and Behavioral Assessment 06/2015; 37(2). DOI:10.1007/s10862-014-9461-y · 1.55 Impact Factor
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    • "Considering the most popular existing standardized diagnostic interviews (SDIs) and the efforts to modify them for clinicians' use, the literature indicates that psychiatrists do not use the existing structured interviews or rating scales in real clinical settings (Gilbody et al., 2002; Duffy et al., 2008; Morrison, 2008; Aboraya, 2009; Nasrallah, 2009; Rettew et al., 2009; Bastiaens, 2011; Busner et al., 2011). Considering these serious gaps in the literature, namely the lack of an instrument designed for psychiatrists to use in clinical settings and the lack of a clinician-administered tool with dimensional measures, the first author devised the Standard for Clinicians' Interview in Psychiatry (SCIP). "
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    ABSTRACT: Background: Existing standardized diagnostic interviews are not used by psychiatrists in clinical settings. There is an urgent need for a clinician-administered tool for assessment of adult psychopathology that produces dimensional measures, in addition to categorical diagnoses. Methods: The Standard for Clinicians' Interview in Psychiatry (SCIP) was designed to be used in clinical settings and generates dimensional measures. The reliability of the SCIP was tested at six sites: one hospital and two clinics in USA, two hospitals in Egypt and one clinic in Canada. Participants were adult patients who were admitted for inpatient psychiatric treatment or came for regular office visits in the outpatient clinic. Refusal rate was <1%. Missing data were <1.1%. Patients with dementia, mental retardation or serious medical conditions were excluded. A total of 1,004 subjects were interviewed between 2000 and 2012. Results: Inter-rater reliability (Kappa) was measured for 150 SCIP items: 116 items (77.3%) had good reliability (Kappa>0.7), 28 items (18.7%) had fair reliability (Kappa ranges from 0.5 to 0.7) and six items (4%) had poor reliability (Kappa<0.5). Cronbach's alpha for internal consistency was measured for the SCIP dimensions: anxiety, posttraumatic stress, depression, mania, hallucinations, Schneider first-rank symptoms, delusions, disorganized thoughts, disorganized behavior, negative symptoms, alcohol addiction, drug addiction, attention and hyperactivity. All of the SCIP dimensions had substantial Cronbach's alpha values (>0.7) with the exception of disorganized thoughts (Cronbach's alpha=0.375). Conclusions: The SCIP is a reliable tool for assessing psychological symptoms, signs and dimensions of the main psychiatric diagnoses.
    Schizophrenia Research 07/2014; 156(2-3). DOI:10.1016/j.schres.2014.04.025 · 3.92 Impact Factor
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    • "In addition, Epstein and colleagues (Epstein et al. 2008, 2010) found that the collaborative method was successful in significantly increasing primary care physicians' adoption and sustainability of evidence-based practice guidelines for the diagnosis and treatment of ADHD. Adult mental health studies of the collaborative method have also examined implementation outcomes and found positive effects on outcomes such as adoption, fidelity, and acceptability (e.g., Duffy et al. 2008; Vannoy et al. 2011; Versteeg et al. 2012). "
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    ABSTRACT: Background Given dismal attendance rates in community-based care for children and families, it is critical that evidence-informed attendance engagement strategies be implemented within community service systems. There is growing research on effective methods for training in evidence-based practices (EBPs), and one method that shows promise is the learning collaborative modeled after the Institute for Healthcare Improvement’s Breakthrough Series Collaborative framework. Objective This study examines implementation outcomes of a learning collaborative based on the Breakthrough Series Collaborative that was conducted to improve attendance engagement in community-based early childhood intervention programs using evidence-informed strategies. Methods A total of 29 providers from four programs within a large regional hospital participated. Qualitative and quantitative data collected prior, during, and at the completion of the 9-month learning collaborative as part of a process evaluation. Data were analyzed to examine the feasibility, acceptability, adoption and fidelity, and planned sustainability of strategies to facilitate attendance engagement as a result of the learning collaborative. Results Results indicate that: (1) using a learning collaborative implementation method with early intervention providers was feasible; (2) the method was acceptable based on perceived improvements in attendance and a significant increase in attitudes towards EBPs; (3) the method supported successful self-reported adoption and fidelity of engagement strategies; and (4) the method facilitated planned sustainability of practice changes. Conclusions The learning collaborative can be a useful implementation strategy within early childhood intervention programs to promote the use of EBPs, including enhancing attendance engagement through evidence-informed strategies.
    Child and Youth Care Forum 10/2013; 42(5). DOI:10.1007/s10566-013-9210-5 · 1.25 Impact Factor
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