title: Enhancing electronic health record measurement of depression severity and suicide ideation: a Distributed Ambulatory Research in Therapeutics Network (DARTNet) study.
abstract: BACKGROUND
  Depression is a leading cause of morbidity worldwide. The majority of treatment for depression occurs in primary care, but effective care remains elusive. Clinical decision making and comparative studies of real-world antidepressant effectiveness are limited by the absence of clinical measures of severity of illness and suicidality.
  
  
  METHODS
  The Distributed Ambulatory Research in Therapeutics Network (DARTNet) was engaged to systematically collect data using the 9-item Patient Health Questionnaire (PHQ-9) at the point of care. We used electronic health records (EHRs) and the PHQ-9 to capture, describe, and compare data on both baseline severity of illness and suicidality and response and suicidality after diagnosis for depressed patients in participating DARTNet practices.
  
  
  RESULTS
  EHR data were obtained for 81,028 episodes of depression (61,464 patients) from 14 clinical organizations. Over 9 months, data for 4900 PHQ-9s were collected from 2969 patients in DARTNet practices (this included 1892 PHQ-9s for 1019 adults and adolescents who had at least one depression diagnosis). Only 8.3% of episodes identified in our depression cohort had severity of illness information available in the EHR. For these episodes, considerable variation existed in both severity of illness (32.05% with no depression, 26.89% with minimal, 19.54% with mild, 12.04% with moderate, and 9.47% with severe depression) and suicidality (69.43% with a score of 0, 22.58% with a score of 1, 4.97% with a score of 2, and 3.02% with a score of 3 on item 9 of the PHQ-9). Patients with an EHR diagnosis of depression and a PHQ-9 (n = 1019) had similar severity but slightly higher suicidality levels compared with all patients for which PHQ-9 data were available. The PHQ-9 showed higher sensitivity for identifying depression response and emergent (after diagnosis) severity and suicidality; 25% to 30% of subjects had some degree of suicidal thought at some point in time according to the PHQ-9.
  
  
  CONCLUSIONS
  This study demonstrated the value of adding PHQ-9 data and prescription fulfillment data to EHRs to improve diagnosis and management of depression in primary care and to enable more robust comparative effectiveness research on antidepressants.
authors.affiliation: Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, the American Academy of Family Physicians, Denver, CO, USA. robert.valuck@ucdenver.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Valuck
authors.forename: Heather O
authors.initials: HO
authors.lastname: Anderson
authors.forename: Anne M
authors.initials: AM
authors.lastname: Libby
authors.forename: Elias
authors.initials: E
authors.lastname: Brandt
authors.forename: Cathy
authors.initials: C
authors.lastname: Bryan
authors.forename: Richard R
authors.initials: RR
authors.lastname: Allen
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Staton
authors.forename: David R
authors.initials: DR
authors.lastname: West
authors.forename: Wilson D
authors.initials: WD
authors.lastname: Pace
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000627:therapeutic use; D057186:Comparative Effectiveness Research; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents