Patient self-assessment factors predictive of persistent depressive symptoms 6 months after enrollment in collaborative care management

Depress Anxiety. 2013 Feb;30(2):143-8. doi: 10.1002/da.22020. Epub 2012 Nov 8.


Background: Collaborative care management (CCM) is effective for improving depression outcomes. However, a subset of patients will still have symptoms after 6 months. This study sought to determine whether routinely obtained baseline clinical, demographic, and self-assessment variables would predict which patients endorse persistent depressive symptoms (PDS) after 6 months. By estimating the relative risk associated with the patient variables, we aimed to outline the combinations of factors predictive of PDS after CCM enrollment.

Methods: We retrospectively reviewed 1,110 adult primary care patients with the diagnosis of major depressive disorder enrolled in a CCM program and evaluated those with PDS (defined as patient health questionnaire-9score ≥10) 6 months after enrollment.

Results: At baseline, an increased depression severity, worsening symptoms of generalized anxiety, an abnormal screening on the mood disorder questionnaire (MDQ) and the diagnosis of recurrent episode of depression were independent predictors of PDS. A patient with severe, recurrent depression, an abnormal MDQ screen, and severe anxiety at baseline had a predicted 42.1% probability of PDS at 6 months. In contrast, a patient with a moderate, first episode of depression, normal MDQ screen, and no anxiety symptoms had a low probability of PDS at 6.6%.

Conclusions: This study identified several patient self-assessment scores and clinical diagnosis that markedly predicted the probability of PDS 6 months after diagnosis and enrollment into CCM. Knowledge of these high-risk attributes should alert the clinician to monitor select patients more closely and consider altering therapy appropriately.

MeSH terms

  • Adult
  • Analysis of Variance
  • Depression / diagnosis*
  • Depression / therapy
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Dysthymic Disorder / psychology
  • Dysthymic Disorder / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Care Team / organization & administration*
  • Primary Health Care
  • Retrospective Studies
  • Risk Assessment
  • Self-Assessment*
  • Surveys and Questionnaires
  • Treatment Outcome