1. A Brief Clinical Tool to Estimate Individual Patients’ Risk of Depressive Relapse Following Remission: Proof of Concept
- Author
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Pamela J. Schettler, A. John Rush, and Lewis L. Judd
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Adolescent ,Logistic regression ,Sensitivity and Specificity ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Recurrence ,Risk Factors ,Rating scale ,medicine ,Humans ,Young adult ,Psychiatry ,Depression (differential diagnoses) ,Aged ,Psychiatric Status Rating Scales ,Depressive Disorder, Major ,Remission Induction ,Middle Aged ,medicine.disease ,Mental health ,030227 psychiatry ,Psychiatry and Mental health ,Logistic Models ,Predictive value of tests ,Major depressive disorder ,Anxiety ,Female ,Self Report ,medicine.symptom ,Psychology ,030217 neurology & neurosurgery - Abstract
The authors sought to determine whether symptoms experienced by formerly depressed patients after at least 8 weeks of remission can be used to identify their risk for relapse during the next 6 months.The study included 188 patients with major depressive disorder from the National Institute of Mental Health Collaborative Depression Study who had at least one Symptom Checklist-90 (SCL-90) assessment after at least 8 weeks of full remission from a depressive episode (defined as a value of 1 on the weekly psychiatric rating scale for all depressive conditions, recorded on Longitudinal Follow-Up Evaluation interviews). Mixed logistic regression was used to identify a set of SCL-90 items that were most predictive of relapse compared with nonrelapse within the next 6 months.Of 514 SCL-90 assessments completed after remission, 73 (14.2%) were followed by depressive relapse within 6 months. Seventeen SCL-90 items (including symptoms of depression, anxiety, and psychological vulnerability) significantly distinguished relapse from nonrelapse. Of these, a set of 12 symptoms maximally separated relapse from nonrelapse. Experiencing one or more of these symptoms had a sensitivity of 80.8% and a specificity of 51.2% for identifying a period in which a relapse occurred, with a positive predictive value of 21.5% and a negative predictive value of 94.2%. The relapse rate was 5.8% when none of the 12 symptoms were present, 16.4% when one to five symptoms were present, 34.1% when six to nine symptoms were present, and 72.7% when 10 or more symptoms were present.A brief symptom scale can be used to identify patients who, despite full remission from a depressive episode, are at substantial risk of relapse within the next 6 months, and this can be used to provide a basis for personalizing the intensity of follow-up visits.
- Published
- 2016