Depression Outcomes in Psychiatric Clinical Practice: Using a Self-Rated Measure of Depression Severity

ArticleinPsychiatric services (Washington, D.C.) 62(8):929-35 · August 2011with87 Reads
DOI: 10.1176/ · Source: PubMed
This study determined rates of response and remission at 12 and 24 weeks among patients being treated by psychiatrists for depression on the basis of Patient Health Questionnaire-9 (PHQ-9) scores and identified factors associated with response and remission. Adult patients at 17 psychiatric practices participating in the National Depression Management Leadership Initiative completed the PHQ-9 at every office visit for one year irrespective of severity or chronicity of symptoms or adherence to treatment. Treating psychiatrists recorded the date when formal self-management goals were documented. Patients with a diagnosis of depression and a PHQ-9 score ≥10 were included in the response and remission analysis. Results are based on "last observation carried forward" analysis. Of the 1,763 patients with a depressive disorder, 960 had PHQ-9 scores ≥10 (mean±SD of 16.4±4.6) on their first study visit, indicating moderate to severe depression. At 12 weeks, 41% of the 792 who returned for follow-up had responded to treatment, and by 24 weeks 45% had responded. Response was defined as a PHQ-9 score <10. Symptoms were in remission for 13% and 18% of patients at 12 and 24 weeks, respectively. Severity of initial PHQ-9 score, weeks to first follow-up, and documented self-management were the three factors that predicted remission. Administering the PHQ-9 at each visit allowed psychiatrists to determine rates of response and remission among patients, but as anticipated, the rates were lower than those reported in trials of efficacy and effectiveness of psychiatric treatment of depression.
  • [Show abstract] [Hide abstract] ABSTRACT: There is no published evidence on the adequacy of depression care among college students and how this varies by subpopulations and provider types. We estimated the prevalence of minimally adequate treatment among students with significant past-year depressive symptoms. Data were collected via a confidential online survey of a random sample of 8488 students from 15 colleges and universities in the 2009 Healthy Minds Study. Depressive symptoms were assessed by the Patient Health Questionnaire-2, adapted to a past-year time frame. Students with probable depression were coded as having received minimally adequate depression care based on the criteria from Wang and colleagues (2005). Minimally adequate treatment was received by only 22% of depressed students. The likelihood of minimally adequate treatment was similarly low for both psychiatric medication and psychotherapy. Minimally adequate care was lower for students prescribed medication by a primary care provider as compared to a psychiatrist (P<.01). Racial/ethnic minority students were less likely to receive depression care (P<.01). Adequacy of depression care is a significant problem in the college population. Solutions will likely require greater availability of psychiatry care, better coordination between specialty and primary care using collaborative care models, and increased efforts to retain students in psychotherapy.
    Article · Feb 2012
  • [Show abstract] [Hide abstract] ABSTRACT: Aim The impact of initial severity of depression on the rate of remission has not been well studied. The hypothesis for this study was that increased depression severity would have an inverse relationship on clinical remission at six months while in collaborative care management. Participants The study cohort was 1128 primary care patients from a south-eastern Minnesota practice and was a longitudinal retrospective chart review analysis. Results Clinical remission at six months was less likely in the severe depression group at 29.6% compared with 36.9% in the moderately severe group and 45.6% in the moderate depression group (P < 0.001). Multivariate analysis of a sub-group demonstrated that increased initial anxiety symptoms (odds ratio [OR] 0.9645, 95% confidence interval [CI] 0.9345-0.9954, P = 0.0248) and an abnormal screening for bipolar disorder (OR 0.4856, 95% CI 0.2659-0.8868, P = 0.0187) predicted not achieving remission at six months. A patient with severe depression was significantly less likely to achieve remission at six months (OR 0.6040, 95% CI 0.3803-0.9592, P = 0.0327) compared with moderate depression, but not moderately severe depression (P = 0.2324). There was no statistical difference in the adjusted means of the PHQ-9 score for those patients who were in remission at six months. However, in the unremitted patients, the six-month PHQ-9 score was significantly increased by initial depression severity when controlling for all other variables. Conclusion Multivariate analysis in our study demonstrated that patients with severe depression have a decreased OR for remission at six months compared with moderate depression. Also, there was a significant increase in the six-month PHQ-9 score for those unremitted patients in the severe vs. moderate depression groups.
    Full-text · Article · Jun 2012
  • [Show abstract] [Hide abstract] ABSTRACT: Background: It has been suggested that clinician-rated scales and self-report questionnaires may be interchangeable in the measurement of depression severity, but it has not been tested whether clinically significant information is lost when assessment is restricted to either clinician-rated or self-report instruments. The aim of this study is to test whether self-report provides information relevant to short-term treatment outcomes that is not captured by clinician-rating and vice versa. Methods: In genome-based drugs for depression (GENDEP), 811 patients with major depressive disorder treated with escitalopram or nortriptyline were assessed with the clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Rating Scale for Depression (HRSD), and the self-report Beck Depression Inventory (BDI). In sequenced treatment alternatives to relieve depression (STAR*D), 4,041 patients treated with citalopram were assessed with the clinician-rated and self-report versions of the Quick Inventory of Depressive Symptomatology (QIDS-C and QIDS-SR) in addition to HRSD. Results: In GENDEP, baseline BDI significantly predicted outcome on MADRS/HRSD after adjusting for baseline MADRS/HRSD, explaining additional 3 to 4% of variation in the clinician-rated outcomes (both P < .001). Likewise, each clinician-rated scale significantly predicted outcome on BDI after adjusting for baseline BDI and explained additional 1% of variance in the self-reported outcome (both P < .001). The results were confirmed in STAR*D, where self-report and clinician-rated versions of the same instrument each uniquely contributed to the prediction of treatment outcome. Conclusions: Complete assessment of depression should include both clinician-rated scales and self-reported measures.
    Article · Dec 2012
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