Patient questionnaire for depression helpful.

PHOENIX--Clinicians in 17 diverse outpatient psychiatric practices across the United States reported that having patients complete a simple, short questionnaire about depression at each visit was helpful in 93% of visits and led to treatment changes in 40% of patient contacts.

The nine-item depression scale of the Patient Health Questionnaire (PHQ-9) was completed by every new and returning adult patient over a 1-year period for screening, diagnosis, and monitoring of depression. Previous studies have suggested that the questionnaire is useful in primary care practices, but this is the first study among psychiatrists.

The PHQ-9 is a self-administered version of the Primary Care Evaluation of Mental Disorders, and contains the nine items listed in the DSM-IV for depression symptoms and severity, Dr. David J. Katzelnick said at a poster presentation at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

"Obviously, all psychiatrists know those items. How helpful could this be?" he asked. "It made a huge difference," he added.

In 3% of visits, psychiatrists picked up suicidality "that they didn't realize was there beforehand," which prompted them to further assess suicide risk, reported Dr. Katzelnick of Healthcare Technology Systems Inc., Madison, Wis., and his associates.

The PHQ-9 confirmed the appropriateness of treatment in 60% of visits. During the other 40% of visits, the most common changes were an adjustment in antidepressant dose in 45%, the addition of another antidepressant in 26%, a start or increase in psychotherapy in 16%, a change in antidepressants in 13%, or the start of antidepressant therapy in 10%. Psychiatrists reassessed the diagnosis in 1% and referred patients in 1% of visits. (More than one change could take place per visit.)

Additional data from 16 of the psychiatric practices a year after the study ended showed that 15 were still using the PHQ-9 for screening, diagnosis, and monitoring of patients, said Farifteh F. Duffy, Ph.D., lead author of the poster. "They're doing an amazing job of spreading this to other practices" by sharing the PHQ-9 with colleagues in ob.gyn. and primary care, added Dr. Duffy of the American Psychiatric Institute for Research and Education, Arlington, Va.

The proportions of patients who achieved remission of depression during the 1-year study fell in between results seen in two separate trials of more rigorous stepwise algorithms for diagnosing and monitoring depression that are less practical in routine care, she said. Remission rates were 33% in the Standards for Reporting of Diagnostic Accuracy (STARD) study, 15% in the PHQ-9 study, and 11% in the Texas Medication Algorithm Project (TMAP). Response rates were significantly lower in the PHQ-9 study (33%), compared with the STARD study (47%).

More research is needed to show that incorporating the PHQ-9 into routine practice improves patient outcomes.

The study was funded by the American Psychiatric Foundation through unrestricted grants from companies that make antidepressants--AstraZeneca International, Eli Lilly & Co., Forest Laboratories, Pfizer Inc., Sanofi-Aventis, and Wyeth. The investigators have no other potential conflicts of interest.

The current study began as a joint effort by the American Psychiatric Association, the American College of Physicians, and the American Academy of Family Physicians to standardize care of depression. "We wanted to come up with a standard way of tracking depression severity in the same way that hemoglobin [A.sub.1c] does for diabetes," Dr. Katzelnick said. "There are 10-15 potential measures that you could use, but unless you have a standard, it doesn't move the field."

The results have led the Mayo Clinic and the New York City health department (two of the participants in the study) to begin disseminating the PHQ-9 throughout their systems, Dr. Katzelnick said.

The investigators have received a grant from the U.S. Department of Defense to choose and test a tool for routine management of posttraumatic stress disorder, Dr. Duffy said. Other scales could prove useful for managing generalized anxiety disorder, alcohol abuse, eating disorders, or bipolar disorder, Dr. Katzelnick added.

Psychiatrits know the items listed in the DSM for depression. Still, the PHQ-9 made a 'huge difference'.

BY SHERRY BOSCHERT

San Francisco Bureau