Psychiatric Disease

Outpatient Treatment for Mood and Anxiety Disorders

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

2020

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

PHQ-9 Scores

Of the 3766 adult outpatients with at least moderate depression, defined as a baseline Patient Health Questionnaire (PHQ-9) score ≥ 10 (N =1765), 37.8% (N = 668) demonstrated a clinically meaningful improvement, 55% (N = 971) remained stable, and 7.1% (N = 126) 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 2020 for whom initial and follow-up data were available. Median duration between initial and follow-up assessment was 90 days (range, 1-356).

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 2712 patients with at least 2 visits in 2020. Among those patients whose baseline PROMIS-10 Mental Health score ≤ 45 (N = 1875), 21.4% (N = 402) showed improvement, 63.6% (N = 1192) remained stable, and 15% (N = 281) worsened. Median duration of follow-up was 129 days (range, 1-359).

PROMIS-10 Physical Health Scores

PROMIS-10 Physical Health data were available for analysis on 2711 patients with at least 2 visits in 2020. Among those patients whose baseline PROMIS-10 Physical Health score ≤ 45 (N = 1474), 27.2% (N = 401) showed improvement, 62.6% (N = 922) remained stable, and 10.2% (N = 151) worsened. Median duration of follow-up was 143 days (range, 1-359).

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.