Patty Chondros1, Sandra Davidson2, Rory Wolfe3, Gail Gilchrist4, Christopher Dowrick5, Frances Griffiths6, Kelsey Hegarty2, Helen Herrman7, Jane Gunn2. 1. Department of General Practice, The University of Melbourne, Australia. Electronic address: p.chondros@unimelb.edu.au. 2. Department of General Practice, The University of Melbourne, Australia. 3. Department of Epidemiology and Preventive Medicine, Monash University, Australia. 4. Department of General Practice, The University of Melbourne, Australia; National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom. 5. Department of General Practice, The University of Melbourne, Australia; Institute of Psychology, Health and Society, University of Liverpool, United Kingdom. 6. Department of General Practice, The University of Melbourne, Australia; WMS-Social Science and Systems in Health, University of Warwick, United Kingdom. 7. Orygen, The National Centre of Excellence in Youth Mental Health, and Centre for Youth Mental Health, The University of Melbourne, Australia.
Abstract
BACKGROUND: Depression trajectories among primary care patients are highly variable, making it difficult to identify patients that require intensive treatments or those that are likely to spontaneously remit. Currently, there are no easily implementable tools clinicians can use to stratify patients with depressive symptoms into different treatments according to their likely depression trajectory. We aimed to develop a prognostic tool to predict future depression severity among primary care patients with current depressive symptoms at three months. METHODS: Patient-reported data from the diamond study, a prospective cohort of 593 primary care patients with depressive symptoms attending 30 Australian general practices. Participants responded affirmatively to at least one of the first two PHQ-9 items. Twenty predictors were pre-selected by expert consensus based on reliability, ease of administration, likely patient acceptability, and international applicability. Multivariable mixed effects linear regression was used to build the model. RESULTS: The prognostic model included eight baseline predictors: sex, depressive symptoms, anxiety, history of depression, self-rated health, chronic physical illness, living alone, and perceived ability to manage on available income. Discrimination (c-statistic =0.74; 95% CI: 0.70-0.78) and calibration (agreement between predicted and observed symptom scores) were acceptable and comparable to other prognostic models in primary care. LIMITATIONS: More complex model was not feasible because of modest sample size. Validation studies needed to confirm model performance in new primary care attendees. CONCLUSION: A brief, easily administered algorithm predicting the severity of depressive symptoms has potential to assist clinicians to tailor treatment for adult primary care patients with current depressive symptoms.
BACKGROUND:Depression trajectories among primary care patients are highly variable, making it difficult to identify patients that require intensive treatments or those that are likely to spontaneously remit. Currently, there are no easily implementable tools clinicians can use to stratify patients with depressive symptoms into different treatments according to their likely depression trajectory. We aimed to develop a prognostic tool to predict future depression severity among primary care patients with current depressive symptoms at three months. METHODS:Patient-reported data from the diamond study, a prospective cohort of 593 primary care patients with depressive symptoms attending 30 Australian general practices. Participants responded affirmatively to at least one of the first two PHQ-9 items. Twenty predictors were pre-selected by expert consensus based on reliability, ease of administration, likely patient acceptability, and international applicability. Multivariable mixed effects linear regression was used to build the model. RESULTS: The prognostic model included eight baseline predictors: sex, depressive symptoms, anxiety, history of depression, self-rated health, chronic physical illness, living alone, and perceived ability to manage on available income. Discrimination (c-statistic =0.74; 95% CI: 0.70-0.78) and calibration (agreement between predicted and observed symptom scores) were acceptable and comparable to other prognostic models in primary care. LIMITATIONS: More complex model was not feasible because of modest sample size. Validation studies needed to confirm model performance in new primary care attendees. CONCLUSION: A brief, easily administered algorithm predicting the severity of depressive symptoms has potential to assist clinicians to tailor treatment for adult primary care patients with current depressive symptoms.
Authors: Benjamin L Brett; Zachary Y Kerr; Samuel R Walton; Avinash Chandran; J D Defreese; Rebekah Mannix; Ruben J Echemendia; William P Meehan; Kevin M Guskiewicz; Michael McCrea Journal: J Neurol Neurosurg Psychiatry Date: 2021-10-18 Impact factor: 10.154