A call for standardized measurement of outcomes in depression treatment

Rhode Island Hospital and Brown University researchers are calling on clinicians to adopt a standardized measurement of outcomes when treating depression. The commentary was published in the June edition of Primary Psychiatry.

Researchers led by Mark Zimmerman, M.D., noted that quantified measurement of outcome is rarely done when treating depression, yet to determine the impact of treatment it is necessary to evaluate outcome. It provides the clinician with a concrete way to assess the degree and completeness of treatment success. However, studies among clinicians in both the United States and the United Kingdom confirm that the vast majority of psychiatrists did not routinely use scales to monitor outcome when treating depression, with less than 10 percent reporting that they always used scales to monitor outcome.

Zimmerman and the researchers determined that one issue serving as an obstacle to evaluating outcomes is a perception of the added burden, as clinicians are already overburdened with paperwork. Because of this, the Rhode Island Hospital team has suggested the use of a self-report questionnaire as a cost-effective option that highly correlates with clinician ratings. A self-report can be brief and will provide clinicians with useful information, improve the efficiency of conducting their clinical evaluation and therefore this measure has a practical value for the clinician.

In addition, the team developed a scale for clinical utility. Known as the Clinically Useful Depression Outcome Scale (CUDOS), it contains 18 items that assess all of the DSM-IV inclusion criteria for major depressive disorder and dysthymic disorder as well as psychosocial impairment and quality of life. The 16 symptoms items are rated on a 5-point Likert scale in order to keep the scale brief. Studies by the research team found the CUDOS to be a reliable and valid measure of depressive symptoms that is sensitive to clinical change and can be used to determine whether depressed patients have remitted from treatment.

Zimmerman notes, "Unlike other areas of medical care that can measure outcomes on numerical values like body temperature, blood pressure and other quantifiable variables, psychiatry is the only medical discipline in which quantified measurements of outcome are not the standard of care. We believe that it is critical to do so, and that systematic outcome assessment will assume an increasing importance during the next decade, if for no other reason that payor mandates will require it."

Zimmerman concludes, "There may be only limited data suggesting that measurement might improve outcome when treating depression; however, there is no reason to wait until such studies are done to provide the benefit of measurement-based care in the treatment of depression. Frankly, there is little downside to adopting this approach as part of an overall treatment plan for the depressed patient."

The commentary and the ensuing recommendations are from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, for which Zimmerman is the principal investigator. Zimmerman said, "The MIDAS project is unique in its integration of research quality diagnostic methods into a community-based outpatient practice affiliated with an academic medical center."

Source: Lifespan

Related stories:

Treating patients with psychiatric disorders for hepatitis C
People with severe mental illnesses are far more likely to be infected with Hepatitis C virus compared to the general population, however, they often do not get treatment for their liver disease because current antiviral therapies have known psychiatric side effects.
Researchers find lower response rates to antidepressants with African-Americans, Latinos
Drawing from data in the nation's largest real-world study of treatment-resistant depression, a team led by researchers at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed) reported in November’s Medical Care journal that African-Americans and Latinos didn’t respond as well as whites to medication for their depression.
Placebo study frames depression treatment puzzle
Treating major depression can be quite a puzzle, and a newly published UCLA study suggests medication is just one of many potential pieces.
Researchers propose minocycline as a promising drug for patients with Fragile X syndrome
A UC Riverside-led team of biomedical scientists has found that a readily available drug called minocycline, used widely to treat acne and skin infections, can be used to treat Fragile X syndrome, the most common inherited cause of mental impairment and the most common cause of autism.
No longer depressed, or on meds
Henry Quant was just 5 years old and bedridden with chronic fevers when he began taking pills for anxiety and depression. His mother knew that the drugs helped, but they made her nervous.
Young women w/ early form of breast cancer no more likely to experience recurrence than older women
Young women with DCIS, a common form of early breast cancer that arises in and is confined to the mammary ducts, are presumed more likely to have recurrences than older women with the same diagnosis. But a new study from Fox Chase Cancer Center rebuffs this conventional thinking.
Out of Iraq emerges hope for those with the severest of head injuries
There may be more hope than has been recognized for some people with severe brain injuries, according to a U.S. neurosurgeon who earlier this year spent four months in Iraq treating soldiers and civilians. Jason Huang, M.D., this week presented his results from his experience in Iraq at the annual meeting of the Congress of Neurological Surgeons in Orlando, Fla.
Researchers disclose key advance in treating spinal cord injuries
Researchers in Rochester, N.Y., and Colorado have shown that manipulating stem cells prior to transplantation may hold the key to overcoming a critical obstacle to using stem cell technology to repair spinal cord injuries.

News discussion:

Medicine & Health news