title: Patient self-assessment factors predictive of persistent depressive symptoms 6 months after enrollment in collaborative care management.
abstract: BACKGROUND
  Collaborative care management (CCM) is effective for improving depression outcomes. However, a subset of patients will still have symptoms after 6 months. This study sought to determine whether routinely obtained baseline clinical, demographic, and self-assessment variables would predict which patients endorse persistent depressive symptoms (PDS) after 6 months. By estimating the relative risk associated with the patient variables, we aimed to outline the combinations of factors predictive of PDS after CCM enrollment.
  
  
  METHODS
  We retrospectively reviewed 1,110 adult primary care patients with the diagnosis of major depressive disorder enrolled in a CCM program and evaluated those with PDS (defined as patient health questionnaire-9score ≥10) 6 months after enrollment.
  
  
  RESULTS
  At baseline, an increased depression severity, worsening symptoms of generalized anxiety, an abnormal screening on the mood disorder questionnaire (MDQ) and the diagnosis of recurrent episode of depression were independent predictors of PDS. A patient with severe, recurrent depression, an abnormal MDQ screen, and severe anxiety at baseline had a predicted 42.1% probability of PDS at 6 months. In contrast, a patient with a moderate, first episode of depression, normal MDQ screen, and no anxiety symptoms had a low probability of PDS at 6.6%.
  
  
  CONCLUSIONS
  This study identified several patient self-assessment scores and clinical diagnosis that markedly predicted the probability of PDS 6 months after diagnosis and enrollment into CCM. Knowledge of these high-risk attributes should alert the clinician to monitor select patients more closely and consider altering therapy appropriately.
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. angstman.kurt@mayo.edu
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Angstman
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Shippee
authors.forename: Kathy L
authors.initials: KL
authors.lastname: Maclaughlin
authors.forename: Norman H
authors.initials: NH
authors.lastname: Rasmussen
authors.forename: John M
authors.initials: JM
authors.lastname: Wilkinson
authors.forename: Mark D
authors.initials: MD
authors.lastname: Williams
authors.forename: David J
authors.initials: DJ
authors.lastname: Katzelnick
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003863:Depression / Q000175:diagnosis* / Q000628:therapy; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome