title: One-year clinical outcomes of depressed public sector outpatients: a benchmark for subsequent studies.
abstract: BACKGROUND
  The symptomatic outcomes of a cohort of public mental health sector depressed outpatients treated for 1 year are described to provide a benchmark for future long-term trials. Baseline moderators of outcome were evaluated.
  
  
  METHODS
  Outpatients with nonpsychotic major depressive disorder (n = 118) scoring >/=30 on the 30-item Inventory of Depressive Symptomatology-Clinician Rating (IDS-C(30)) were treated with a medication algorithm and patient/family education package. Response and remission rates were assessed every 3 months with the IDS-C(30). Logistic regression analyses evaluated several baseline features in relation to outcome.
  
  
  RESULTS
  While response and remission rates increased from 3 to 12 months, the 1-year last observation carried forward (LOCF) response (26.3%) and remission (11.0%) rates were not impressive (sustained response = 14.4%; sustained remission = 5.1%). Younger patients and those with full-time employment (at baseline) were more likely to respond. A shorter length of illness tended to be associated with higher response and remission rates (p <.10). Results are generalizable to public sector patients with substantial socioeconomic, general medical, and educational disadvantages who were sufficiently depressed to recommend a change in antidepressant medication.
  
  
  CONCLUSIONS
  Response and remission rates were modest when compared with outcomes in shorter duration efficacy trials in depressed outpatients with less chronicity, fewer concurrent general medical conditions, and less treatment resistance. Results support the need for more powerful treatments and/or the better delivery of available treatments.
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
authors.forename: Madhukar
authors.initials: M
authors.lastname: Trivedi
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Carmody
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Biggs
authors.forename: Kathy
authors.initials: K
authors.lastname: Shores-Wilson
authors.forename: Hisham
authors.initials: H
authors.lastname: Ibrahim
authors.forename: M Lynn
authors.initials: ML
authors.lastname: Crismon
mesh_terms: D000328:Adult; D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use; D019985:Benchmarking; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods*; D011446:Prospective Studies; D017150:Public Sector; D012107:Research Design; D012720:Severity of Illness Index; D013781:Texas; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents