Measurement-Based Care for Unipolar Depression

Morris, David W.; Trivedi, Madhukar H.

doi:10.1007/s11920-011-0237-8

Cited by 35 publications

(18 citation statements)

References 49 publications

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“…Systematic use of the PHQ (or some other standard outcome assessment) is an essential element of effective depression treatment (38, 39). If providers routinely assess severity of depression, they will frequently encounter self-reported suicidal ideation.…”

Section: Discussionmentioning

confidence: 99%

Does Response on the PHQ-9 Depression Questionnaire Predict Subsequent Suicide Attempt or Suicide Death?

et al. 2013

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Objective-As use of standard depression questionnaires in clinical practice increases, clinicians will frequently encounter patients reporting suicidal ideation. We examine whether responses to a brief self-report depression questionnaire predict subsequent suicide attempt or suicide death.Methods-Electronic records from a large integrated health system were used to link PHQ9 depression questionnaires from outpatient visits to subsequent suicide attempts and suicide deaths. 84,418 outpatients aged 13 and older completed 207,625 questionnaires between 1/1/2007 and 12/31/2011. Electronic medical records, insurance claims, and death certificate data identified 709 subsequent suicide attempts and 46 suicide deaths in this sample.Results-Cumulative risk of non-fatal or fatal suicide attempt over one year increased from 0.4% among those reporting suicidal ideation "not at all" to 4% among those reporting suicidal ideation "nearly every day". Self-reported suicidal ideation remained a strong predictor of subsequent suicide attempt after adjusting for age, sex, treatment history, and overall depression severity. Cumulative risk of suicide death over one year increased from 0.03% among those reporting suicidal ideation "not at all" to 0.3% among those reporting suicidal ideation "nearly every day". Self-reported suicidal ideation remained a moderate predictor of subsequent suicide death after adjusting for age, sex, treatment history, and overall depression severity.Conclusions-Response to item 9 of the PHQ9 depression questionnaire identifies outpatients at increased risk for suicide attempt or death. This excess risk emerges over several days and continues to grow for several months, indicating that suicidal ideation is an enduring vulnerability rather than a short-term crisis. Suicide ranks 10th among causes of death in the US, accounting for 38,000 deaths in 2010 (1). Non-fatal suicide attempts cause approximately 600,000 emergency room visits (2) and 200,000 hospitalizations (3) annually. Early intervention to reduce this morbidity and mortality would require both accurate screening tests and effective interventions for those found to be at risk. While some behavioral interventions have shown promise for preventing suicidal behavior in high-risk patients (4, 5), we have no evidence that any screening test accurately identifies people in the general population at risk for suicide attempt or suicide death (6, 7). Consequently, the US Preventive Services Task Force (6), and others (8, 9) do not recommend screening for risk of suicidal behavior. NIH Public AccessNevertheless, increasing use of standard questionnaires in depression treatment (10)(11)(12)(13)(14) means that clinicians will frequently encounter patients who report thoughts of suicide (14,15). At this time, we cannot offer clinicians any clear guidance regarding immediate or longterm risk in outpatients reporting suicidal ideation. Cross-sectional research has demonstrated that suicidal ideation on self-report questionnaires does agree with clinici...

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Section: Discussionmentioning

confidence: 99%

Does Response on the PHQ-9 Depression Questionnaire Predict Subsequent Suicide Attempt or Suicide Death?

et al. 2013

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“…In many but not all cases, these terms refer to a process in which the clinician obtains client progress and outcome data by administering validated measures across treatment. Throughout this paper, we will adopt the term measurement-based care (MBC) to refer to a procedure that can be broadly defined as the use of systematic data collection to monitor client progress and directly inform care decisions (Morris & Trivedi, 2011; Trivedi et al, 2006). Preliminary research suggests that MBC, when used as a framework to guide practice, results in superior client outcomes when compared to usual care (Lambert et al, 2002).…”

Section: Measurement-based Carementioning

confidence: 99%

“…These observed improvements in client outcomes have been tied to MBC’s role in alerting clinicians to lack of progress, which then encourages the clinician to alter the intervention accordingly (Lambert et al, 2003; Morris & Trivedi, 2011). That is, depending on the measure (e.g., established, psychometrically validated depression symptoms) or approach (e.g., idiographic assessment) used, MBC can provide important information about targets for clinician intervention.…”

Section: Mbc Utility Across Stakeholder Levelsmentioning

confidence: 99%

Using Measurement-Based Care to Enhance Any Treatment

Scott

Lewis

2015

Cognitive and Behavioral Practice

365

293

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Measurement-based care (MBC) can be defined as the practice of basing clinical care on client data collected throughout treatment. MBC is considered a core component of numerous evidence-based practices (e.g., Beck & Beck, 2011; Klerman, Weissman, Rounsaville, & Chevron, 1984) and has emerging empirical support as an evidence-based framework that can be added to any treatment (Lambert et al., 2003, Trivedi et al., 2007). The observed benefits of MBC are numerous. MBC provides insight into treatment progress, highlights ongoing treatment targets, reduces symptom deterioration, and improves client outcomes (Lambert et al., 2005). Moreover, as a framework to guide treatment, MBC has transtheoretical and transdiagnostic relevance with broad reach across clinical settings. Although MBC has primarily focused on assessing symptoms (e.g., depression, anxiety), MBC can also be used to assess valuable information about (a) symptoms, (b) functioning and satisfaction with life, (c) putative mechanisms of change (e.g., readiness to change), and (d) the treatment process (e.g., session feedback, working alliance). This paper provides an overview of the benefits and challenges of MBC implementation when conceptualized as a transtheoretical and transdiagnostic framework for evaluating client therapy progress and outcomes across these four domains. The empirical support for MBC use is briefly reviewed, an adult case example is presented to serve as a guide for successful implementation of MBC in clinical practice, and future directions to maximize MBC utility are discussed.

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“…First, the initial step should be the easiest for clinicians to deliver and for patients to adhere to. Second, the intervention should be self-correcting (68); this approach is analogous to the “measurement-based care” of STAR*D (69-73). …”

Section: The Example Of “Engage”mentioning

confidence: 99%

A model for streamlining psychotherapy in the RDoC era: the example of ‘Engage’

Alexopoulos

Areán

2013

Mol Psychiatry

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A critical task for psychotherapy research is to create treatments that can be used by community clinicians. Streamlining of psychotherapies is a necessary first step for this purpose. We suggest that neurobiological knowledge has reached the point of providing biologically meaningful behavioral targets thus guiding the development of effective, simplified psychotherapies. This view is supported by the Research Domain Criteria (RDoC) Project, which reflects the field’s consensus and recognizes the readiness of neurobiology to guide research in treatment development.

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Measurement-Based Care for Unipolar Depression

Cited by 35 publications

References 49 publications

Does Response on the PHQ-9 Depression Questionnaire Predict Subsequent Suicide Attempt or Suicide Death?

Does Response on the PHQ-9 Depression Questionnaire Predict Subsequent Suicide Attempt or Suicide Death?

Using Measurement-Based Care to Enhance Any Treatment

A model for streamlining psychotherapy in the RDoC era: the example of ‘Engage’

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