Depression outcomes in psychiatric clinical practice: Using a self-rated measure of depression severity

Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.