PATIENT SELF-ASSESSMENT FACTORS PREDICTIVE OF PERSISTENT DEPRESSIVE SYMPTOMS 6 MONTHS AFTER ENROLLMENT IN COLLABORATIVE CARE MANAGEMENT
Article first published online: 8 NOV 2012
© 2012 Wiley Periodicals, Inc.
Depression and Anxiety
Volume 30, Issue 2, pages 143–148, February 2013
How to Cite
Angstman, K. B., Shippee, N. D., MacLaughlin, K. L., Rasmussen, N. H., Wilkinson, J. M., Williams, M. D. and Katzelnick, D. J. (2013), PATIENT SELF-ASSESSMENT FACTORS PREDICTIVE OF PERSISTENT DEPRESSIVE SYMPTOMS 6 MONTHS AFTER ENROLLMENT IN COLLABORATIVE CARE MANAGEMENT. Depress. Anxiety, 30: 143–148. doi: 10.1002/da.22020
- Issue published online: 25 JAN 2013
- Article first published online: 8 NOV 2012
- Manuscript Accepted: 12 OCT 2012
- Manuscript Revised: 5 SEP 2012
- Manuscript Received: 1 JUL 2012
- departmental funds
- community psychiatry;
- primary health care;
Collaborative care management (CCM) is effective for improving depression outcomes. However, a subset of patients will still have symptoms after 6 months. This study sought to determine whether routinely obtained baseline clinical, demographic, and self-assessment variables would predict which patients endorse persistent depressive symptoms (PDS) after 6 months. By estimating the relative risk associated with the patient variables, we aimed to outline the combinations of factors predictive of PDS after CCM enrollment.
We retrospectively reviewed 1,110 adult primary care patients with the diagnosis of major depressive disorder enrolled in a CCM program and evaluated those with PDS (defined as Patient Health Questionnaire-9score ≥10) 6 months after enrollment.
At baseline, an increased depression severity, worsening symptoms of generalized anxiety, an abnormal screening on the Mood Disorder Questionnaire (MDQ) and the diagnosis of recurrent episode of depression were independent predictors of PDS. A patient with severe, recurrent depression, an abnormal MDQ screen, and severe anxiety at baseline had a predicted 42.1% probability of PDS at 6 months. In contrast, a patient with a moderate, first episode of depression, normal MDQ screen, and no anxiety symptoms had a low probability of PDS at 6.6%.
This study identified several patient self-assessment scores and clinical diagnosis that markedly predicted the probability of PDS 6 months after diagnosis and enrollment into CCM. Knowledge of these high-risk attributes should alert the clinician to monitor select patients more closely and consider altering therapy appropriately.