title: Improving the assessment of depression remission with the Remission Evaluation and Mood Inventory Tool.
abstract: OBJECTIVE
  The Remission Evaluation and Mood Inventory Tool (REMIT) is a practical 5-item self-report measure of key positive mood states associated with recovering from depression, as distinct from depressive symptoms per se. The study goal was to identify a clinically useful threshold for interpreting REMIT responses in the context of mild to moderate depressive symptoms.
  
  
  METHODS
  This was a secondary analysis of a cross-sectional dataset initially used to develop and validate the REMIT. Primary care patients being treated for depressive symptoms of either mild or moderate severity (n = 247 and 240, respectively) rated their perceived degree of depression remission prior to completing the Patient Health Questionnaire-8 (PHQ-8) and the REMIT. We summed the totals of the latter two measures to form the PHQ + REMIT index.
  
  
  RESULTS
  Receiver Operating Characteristics analysis indicated that the PHQ + REMIT threshold ≥ 13 was associated with good sensitivity (92%) and acceptable specificity (43%) to the absence of patient-perceived remission. In contrast, the PHQ had only 21% specificity at this sensitivity level. Area under the curve was 0.815 (95% C.I.: 0.765-0.865), which was significantly greater than that of the PHQ-8 alone (area under the curve = 0.745, 95% C.I.: 0.691-0.805, p(diff) = 0.0002). Threshold performance was unaffected by adjustment for demographic characteristics and variation in remission percentage. Compared with standard symptom-based classification, using the REMIT reclassified 27% of mildly symptomatic patients as remitted.
  
  
  CONCLUSIONS
  Using the REMIT with patients who have mild to moderate depressive symptoms improves the assessment of patient-perceived remission, which is indicated by a summed PHQ + REMIT index of less than 13. Longitudinal research is needed to test whether this broadened patient-centered approach to assessing remission improves clinical decision making and long-term outcomes.
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA aikensj@umich.edu.
authors.forename: James E
authors.initials: JE
authors.lastname: Aikens
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Klinkman
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Ananda
authors.initials: A
authors.lastname: Sen
authors.affiliation: Department of Family Medicine, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Nease
mesh_terms: D000328:Adult; D000339:Affect; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011594:Psychometrics / Q000706:statistics & numerical data; D012372:ROC Curve; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Depression; diagnosis; mental health; psychological assessment