title: A Brief Clinical Tool to Estimate Individual Patients' Risk of Depressive Relapse Following Remission: Proof of Concept.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: From the Department of Psychiatry, University of California, San Diego, La Jolla; and the Department of Psychiatry, Duke-National University of Singapore, Singapore.
authors.forename: Lewis L
authors.initials: LL
authors.lastname: Judd
authors.affiliation: From the Department of Psychiatry, University of California, San Diego, La Jolla; and the Department of Psychiatry, Duke-National University of Singapore, Singapore.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schettler
authors.affiliation: From the Department of Psychiatry, University of California, San Diego, La Jolla; and the Department of Psychiatry, Duke-National University of Singapore, Singapore.
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D057566:Self Report; D012680:Sensitivity and Specificity; D055815:Young Adult