TY - JOUR
T1 - A direct comparison of presenting characteristics of depressed outpatients from primary vs. specialty care settings
T2 - Preliminary findings from the STAR*D clinical trial
AU - Gaynes, Bradley N.
AU - Rush, A. John
AU - Trivedi, Madhukar
AU - Wisniewski, Stephen R.
AU - Balasubramani, G. K.
AU - Spencer, Donald C.
AU - Petersen, Timothy
AU - Klinkman, Michael
AU - Warden, Diane
AU - Schneider, Robert K.
AU - Castro, Daniel B.
AU - Golden, Robert N.
N1 - Funding Information:
This project has been funded in whole or in part with Federal funds from the National Institute of Mental Health, National Institutes of Health, under Contract N01MH90003. Dr. Gaynes was supported in part by an NIMH K23 Career Development Award (MH01951-03).
Funding Information:
This project has been funded with Federal funds from the National Institute of Mental Health, National Institutes of Health, under Contract N01MH90003 to UT Southwestern Medical Center at Dallas (P.I.: A.J. Rush). Dr. Gaynes was supported in part by an NIMH K23 Career Development Award (MH01951-03). The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. We would like to thank all the STAR*D investigators for all the help in making this large and complex multicenter study possible and for generating the data for this report.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2005
Y1 - 2005
N2 - Purpose: No study has directly compared the clinical features of depression for patients entering clinical trials using identical enrollment criteria at primary care (PC) and specialty care (SC) settings. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (http://www.star-d.org) provides a unique opportunity to provide this comparison for patients with a major depressive disorder (MDD) requiring treatment. Subjects and Methods: We report baseline data for the first 1500 patients enrolled in this trial involving 41 clinic sites (18 PC, 23 SC). Broadly inclusive eligibility criteria required that patients have a DSM-IV diagnosis of nonpsychotic MDD, have not failed an adequate medication trial during their current episode and score ≥14 on the 17-item Hamilton Rating Scale for Depression (HAM-D17). Primary outcomes included the 30-item Inventory of Depressive Symptomatology-Clinician-Rated (IDS-C30) and the HAM-D17. Results: Specialty care and PC patients had equivalent degrees of depressive severity (IDS-C30=35.8; HAM-D17=20.4). Specialty care patients were almost twice as likely to report a prior suicide attempt than PC patients (21% vs. 12%, P<.0001) and slightly less likely to endorse suicidal ideation in the past week (45.0% vs. 50.8%, P=.006). The only other distinguishing core symptoms were a slightly lower likelihood of PC patients endorsing depressed mood (95.2% vs. 97.7%, P=.032) or anhedonia (66.3% vs. 70.7%, P=.042, IDS-C30) and a lower likelihood of PC patients endorsing weight loss (IDS-C30). HAM-D17 results were identical. Conclusion: Depressive severity was not different, and symptomatic presentations did not differ substantially. Major depressive disorder is more similar than different among patients at SC and PC settings. Thus, similar clinical and research methods for screening, detecting and measuring treatment outcomes can be applied in both settings.
AB - Purpose: No study has directly compared the clinical features of depression for patients entering clinical trials using identical enrollment criteria at primary care (PC) and specialty care (SC) settings. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (http://www.star-d.org) provides a unique opportunity to provide this comparison for patients with a major depressive disorder (MDD) requiring treatment. Subjects and Methods: We report baseline data for the first 1500 patients enrolled in this trial involving 41 clinic sites (18 PC, 23 SC). Broadly inclusive eligibility criteria required that patients have a DSM-IV diagnosis of nonpsychotic MDD, have not failed an adequate medication trial during their current episode and score ≥14 on the 17-item Hamilton Rating Scale for Depression (HAM-D17). Primary outcomes included the 30-item Inventory of Depressive Symptomatology-Clinician-Rated (IDS-C30) and the HAM-D17. Results: Specialty care and PC patients had equivalent degrees of depressive severity (IDS-C30=35.8; HAM-D17=20.4). Specialty care patients were almost twice as likely to report a prior suicide attempt than PC patients (21% vs. 12%, P<.0001) and slightly less likely to endorse suicidal ideation in the past week (45.0% vs. 50.8%, P=.006). The only other distinguishing core symptoms were a slightly lower likelihood of PC patients endorsing depressed mood (95.2% vs. 97.7%, P=.032) or anhedonia (66.3% vs. 70.7%, P=.042, IDS-C30) and a lower likelihood of PC patients endorsing weight loss (IDS-C30). HAM-D17 results were identical. Conclusion: Depressive severity was not different, and symptomatic presentations did not differ substantially. Major depressive disorder is more similar than different among patients at SC and PC settings. Thus, similar clinical and research methods for screening, detecting and measuring treatment outcomes can be applied in both settings.
KW - Clinical trial
KW - Depression
KW - Primary care
KW - Suicidality
UR - http://www.scopus.com/inward/record.url?scp=20044392829&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=20044392829&partnerID=8YFLogxK
U2 - 10.1016/j.genhosppsych.2004.10.003
DO - 10.1016/j.genhosppsych.2004.10.003
M3 - Article
C2 - 15763119
AN - SCOPUS:20044392829
SN - 0163-8343
VL - 27
SP - 87
EP - 96
JO - General Hospital Psychiatry
JF - General Hospital Psychiatry
IS - 2
ER -