Depression follow-up monitoring with the PHQ-9: an open cluster-randomised controlled trial

被引:2
|
作者
Kendrick, Tony [1 ]
Dowrick, Christopher [2 ]
Lewis, Glyn [3 ]
Moore, Michael [1 ]
Leydon, Geraldine M. [2 ]
Geraghty, Adam W. A. [1 ]
Griffiths, Gareth [3 ,4 ]
Zhu, Shihua [1 ]
Yao, Guiqing Lily [5 ]
May, Carl [6 ]
Gabbay, Mark [2 ]
Dewar-Haggart, Rachel [1 ]
Williams, Samantha [1 ]
Bui, Lien [1 ]
Thompson, Natalie [1 ]
Bridewell, Lauren [1 ]
Trapasso, Emilia [2 ]
Patel, Tasneem [2 ]
Mccarthy, Molly [2 ]
Khan, Naila [2 ]
Page, Helen [2 ]
Corcoran, Emma [3 ]
Hahn, Jane Sungmin [3 ]
Bird, Molly [3 ]
Logan, Mekeda X. [3 ]
Ching, Brian Chi Fung [3 ]
Tiwari, Riya [1 ]
Hunt, Anna [1 ]
Stuart, Beth [7 ]
机构
[1] Univ Southampton, Fac Med, Aldermoor Hlth Ctr, Sch Primary Care Populat Sci & Med Educ, Southampton, England
[2] Univ Liverpool, Inst Populat Hlth, Dept Primary Care & Mental Hlth, Liverpool, England
[3] UCL, Div Psychiat, London, England
[4] Univ Southampton, Univ Hosp Southampton NHS Fdn Trust, Southampton Clin Trials Unit, Clin trials, Southampton, England
[5] Univ Leicester, Leicester Clin Trials Unit, Hlth econ, Leicester, England
[6] London Sch Hyg & Trop Med, Fac Publ Hlth & Policy, ed sociol, London, England
[7] Queen Mary Univ London, Wolfson Inst Populat Hlth, Fac Med & Dent, Ctr Evaluat & Methods, London, England
来源
BRITISH JOURNAL OF GENERAL PRACTICE | 2024年 / 74卷 / 744期
关键词
primary health care; mental health; mood disorders; depression; patient reported outcome measures; CLINICAL-OUTCOMES; TREATMENT COMET; FEEDBACK; ANXIETY; SCALE;
D O I
10.3399/BJGP.2023.0539
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background Outcome monitoring of depression treatment is recommended but there a lack of evidence on patient benefit in primary care. Aim To test monitoring depression using the Patient Health Questionnaire (PHQ-9) with patient feedback. Design and setting An open cluster -randomised controlled trial was undertaken in 141 group practices. Method Adults with new depressive episodes were recruited through record searches and opportunistically. The exclusion criteria were as follows: dementia; psychosis; substance misuse; and suicide risk. The PHQ-9 was administered soon after diagnosis, and 10-35 days later. The primary outcome was the Beck Depression Inventory (BDI-II) score at 12 weeks. The secondary outcomes were as follows: BDI-II at 26 weeks; Work and Social Adjustment Scale (WSAS) and EuroQol EQ-5D-5L quality of life at 12 and 26 weeks; antidepressant treatment; mental health and social service contacts; adverse events, and Medical Interview Satisfaction Scale (MISS) over 26 weeks. Results In total, 302 patients were recruited to the intervention arm and 227 to the controls. At 12 weeks, 254 (84.1%) and 199 (87.7%) were followed -up, respectively. Only 40.9% of patients in the intervention had a GP followup PHQ-9 recorded. There was no significant difference in BDI-II score at 12 weeks (mean difference -0.46; 95% confidence interval [CI] = -2.16 to 1.26; adjusted for baseline depression, baseline anxiety, sociodemographic factors, and clustering by practice). EQ-5D-5L quality -of -life scores were higher in the intervention arm at 26 weeks (adjusted mean difference 0.053; 95% CI = 0.013 to 0.093.A clinically significant difference in depression at 26 weeks could not be ruled out. No significant differences were found in social functioning, adverse events, or satisfaction. In a per -protocol analysis, antidepressant use and mental health contacts were significantly greater in patients in the intervention arm with a recorded follow-up PHQ-9 (P P = 0.025 and P = 0.010, respectively). Conclusion No evidence was found of improved depression outcome at 12 weeks from monitoring. The findings of possible benefits over 26 weeks warrant replication, investigating possible mechanisms, preferably with automated delivery of monitoring and more instructive feedback.
引用
收藏
页码:E456 / E465
页数:10
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