Major Depression Symptoms in Primary Care and Psychiatric Care Settings: A Cross-Sectional Analysis

Gaynes, Bradley N.; Rush, A. John; Trivedi, Madhukar H.; Wisniewski, Stephen R.; Balasubramani, Goundappa K.; Spencer, Domina Eberle; Petersen, Timothy; Klinkman, Michael S.; Warden, Diane; Nicholas, Linda M.; Fava, Maurizio

doi:10.1370/afm.641

Cited by 91 publications

(73 citation statements)

References 61 publications

(48 reference statements)

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“…These findings are consistent with those of other research in both clinical trial populations 20 and epidemiologic surveys. 21 Twenty-five to 30% of patients in our study expressed some degree of suicidal ideation according to the PHQ-9, and suicidality was correlated with severity.…”

Section: Discussionsupporting

confidence: 92%

Enhancing Electronic Health Record Measurement of Depression Severity and Suicide Ideation: A Distributed Ambulatory Research in Therapeutics Network (DARTNet) Study

Valuck

Anderson

Libby

et al. 2012

The Journal of the American Board of Family Medicine

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Background: Depression is a leading cause of morbidity worldwide. The majority of treatment for depression occurs in primary care, but effective care remains elusive. Clinical decision making and comparative studies of real-world antidepressant effectiveness are limited by the absence of clinical measures of severity of illness and suicidality.Methods: The Distributed Ambulatory Research in Therapeutics Network (DARTNet) was engaged to systematically collect data using the 9-item Patient Health Questionnaire (PHQ-9) at the point of care. We used electronic health records (EHRs) and the PHQ-9 to capture, describe, and compare data on both baseline severity of illness and suicidality and response and suicidality after diagnosis for depressed patients in participating DARTNet practices.Results: EHR data were obtained for 81,028 episodes of depression (61,464 patients) from 14 clinical organizations. Over 9 months, data for 4900 PHQ-9s were collected from 2969 patients in DARTNet practices (this included 1892 PHQ-9s for 1019 adults and adolescents who had at least one depression diagnosis). Only 8.3% of episodes identified in our depression cohort had severity of illness information available in the EHR. For these episodes, considerable variation existed in both severity of illness (32.05% with no depression, 26.89% with minimal, 19.54% with mild, 12.04% with moderate, and 9.47% with severe depression) and suicidality (69.43% with a score of 0, 22.58% with a score of 1, 4.97% with a score of 2, and 3.02% with a score of 3 on item 9 of the PHQ-9). Patients with an EHR diagnosis of depression and a PHQ-9 (n ‫؍‬ 1019) had similar severity but slightly higher suicidality levels compared with all patients for which PHQ-9 data were available. The PHQ-9 showed higher sensitivity for identifying depression response and emergent (after diagnosis) severity and suicidality; 25% to 30% of subjects had some degree of suicidal thought at some point in time according to the PHQ-9.Conclusions: This study demonstrated the value of adding PHQ-9 data and prescription fulfillment data to EHRs to improve diagnosis and management of depression in primary care and to enable more robust comparative effectiveness research on antidepressants. (J Am Board Fam Med 2012;25:582-593.)

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Section: Discussionsupporting

confidence: 92%

Enhancing Electronic Health Record Measurement of Depression Severity and Suicide Ideation: A Distributed Ambulatory Research in Therapeutics Network (DARTNet) Study

Valuck

Anderson

Libby

et al. 2012

The Journal of the American Board of Family Medicine

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“…30,31 In this study, however, the clear majority of treated patients had DSM-IV diagnoses of major depressive disorder, and the mean BDI-II score indicated depression approaching the moderate range. These findings are similar to the recent larger study by Gaynes and colleagues, 32 who reported that patients with major depressive disorder in primary care settings had equivalent degrees of depression severity (moderate to severe) compared to the patients with major depressive disorder seen in psychiatric care settings.…”

Section: Resultssupporting

confidence: 89%

“…It is also possible that the self-identifiers were being prescribed antidepressants for treatment of anxiety only, but previous studies of primary care populations indicate high rates of comorbid depression and anxiety. 32 Another apparent limitation could be the method of measuring adherence, as it has been suggested that electronic medication monitoring is the gold standard of collecting data on adherence. 41 However, self-report of medi-…”

Section: Resultsmentioning

confidence: 99%

Antidepressant Medication Adherence

Tamburrino¹,

Nagel²,

Chahal³

et al. 2009

Prim. Care Companion J. Clin. Psychiatry

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“…Due to its prominence (~20% in the general population) MDD often is referred to as the "common cold of psychiatry [2,4,5]. Worldwide, MDD causes significant economic ($83 billion in the US alone) and psychosocial burdens due to the cost of hospitalization, lost work productivity and suicide.…”

Section: The Pcp and Mdd In A Primary Care Patient Populationmentioning

confidence: 99%

“…Up to 40% of sufferers remain untreated and suicide is a common consequence; about half of suicide victims visited a PCP within the month prior to their death [2,3,7]. With the advent of multiple SSRIs many more MDD patients now are being treated and maintained in primary care practices [4,8]. Learning how to recognize MDD, therefore, is a major obstacle facing the PCP.…”

Section: The Pcp and Mdd In A Primary Care Patient Populationmentioning

confidence: 99%

Personalized medicine in major depressive disorder — Opportunities and pitfalls

Miller

O’Callaghan

2013

Metabolism

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The sequencing of the human genome in the early days of this millennium was greeted with great fanfare as this accomplishment was expected to revolutionize medicine and result in individualized treatments based on the genetic make-up of the patient. The ultimate promise of personalized medicine would be fulfilled with the identification of disease biomarkers that would be widely available for use in diagnosis and treatment. Progress, however, has been slow in providing disease biomarkers or approved diagnostic tests. This is true for major depressive disorder (MDD), despite its prevalence in the general population and the widespread acceptance of its biological basis. Studies using strategies like genome-wide association and candidate gene analyses have identified a number of possible biomarkers of MDD, including serum levels of neurotrophic factors, inflammatory cytokines and HPA axis hormones, but none have proven sufficiently powerful for clinical use. The lack of biologically based tests available for use in identifying patients with MDD is a significant impediment to personalized and more effective treatment, because it means diagnosis continues to be driven by subjective symptoms. While genetic studies of MDD have not yet led to diagnostic and treatment biomarkers, progress in determining the role of the genome in drug metabolism heralds the first effort in personalized prescribing for the antidepressants. The FDA suggested and approved genotyping tests for common variants of drug metabolism genes, such as the cytochrome p450s. By using these tests a physician can select an appropriate antidepressant for a given patient, as differences in clearance, half-life, and peak blood concentrations are controlled by genetic variability in drug metabolism. Personalization in drug choice can be achieved because these tests: (1) identify responders and non-responders; (2) provide alerts to possible adverse drug events; and (3) help optimize dose. Improved ways of diagnosing and prescribing effective treatments for MDD are needed, as the available methods are inadequate and symptom based. In the foreseeable future, further interrogation of the genome may serve as the basis for development of new personalized medicine strategies for diagnosis and treatment of MDD.

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Major Depression Symptoms in Primary Care and Psychiatric Care Settings: A Cross-Sectional Analysis

Cited by 91 publications

References 61 publications

Enhancing Electronic Health Record Measurement of Depression Severity and Suicide Ideation: A Distributed Ambulatory Research in Therapeutics Network (DARTNet) Study

Enhancing Electronic Health Record Measurement of Depression Severity and Suicide Ideation: A Distributed Ambulatory Research in Therapeutics Network (DARTNet) Study

Antidepressant Medication Adherence

Personalized medicine in major depressive disorder — Opportunities and pitfalls

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