Psychiatric Disease

Outpatient Treatment for Mood and Anxiety Disorders

Improvement in Depressive Symptoms and Global Health-Related Quality of Life Among Adult Outpatients

2021

PHQ-9 = Patient Health Questionnaire, PROMIS = Patient-Reported Outcomes Measurement Information System

PHQ-9 Scores

Of the 6867 adult outpatients with at least moderate depression, defined as a baseline Patient Health Questionnaire (PHQ-9) score ≥ 10 (N = 2951), 42.6% (N = 1258) demonstrated a clinically meaningful improvement, 50.8% (N = 1499) remained stable, and 6.6% (N = 194) worsened. Clinically meaningful improvement was defined as a 5-point reduction in total PHQ-9 score from baseline to follow-up.¹ Outpatients were treated with psychotherapy and/or medication management. N = patients seen for initial assessment of a mood and/or anxiety disorder(s) in 2021 for whom initial and follow-up data were available. Median duration between initial and follow-up assessment was 180 days (range, 1-360).

PROMIS-10 Scores

The Patient-Reported Outcomes Measurement Information System (PROMIS®) Global Health was used to assess global health-related quality of life. The PROMIS-10 is a publicly available assessment tool consisting of 10 items, which are used to measure and provide 2 separate scores for overall mental health and physical health. Scores are standardized to the general population, with a mean T-score = 50 and standard deviation = 10; higher scores indicate better function and percentiles allow more direct comparison with the general population. For example, a percentile of 33.5 indicates that the patient’s score is better than 33.5% of the population. Clinically meaningful change was defined as a 5-point change in T-score, based on one-half the standard deviation.²

PROMIS-10 Mental Health Scores

PROMIS-10 Mental Health data were available for analysis on 5142 patients with at least 2 visits in 2021. Among those patients whose baseline PROMIS-10 Mental Health score ≤ 45 (N = 3805), 29.4% (N = 1118) showed improvement, 60.6% (N = 2305) remained stable, and 10% (N = 382) worsened. Median duration of follow-up was 202 days (range, 1-360).

PROMIS-10 Physical Health Scores

PROMIS-10 Physical Health data were available for analysis on 5163 patients with at least 2 visits in 2021. Among those patients whose baseline PROMIS-10 Physical Health score ≤ 45 (N = 2802), 28.5% (N = 799) showed improvement, 59.7% (N = 1672) remained stable, and 11.8% (N = 331) worsened. Median duration of follow-up was 208 days (range, 1-360).

References
  1. Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care. 2004 Dec;42(12):1194-1201.
  2. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003 May;41(5):582-592.