Patient-reported outcome measures in depression

Abstract

Aim

Patient-reported outcome measures (PROMs) are increasingly important as a mean for quality assurance. Feasible estimates of recovery can be achieved through the application of Jacobson plots, which is a simple demonstration of the outcome of each case, recommended for clinical use. We applied this approach with PROMs collected regarding group psychotherapy in a mental health service (MHS) setting. We hypothesized a recovery rate of above 50% of all cases, expecting a lower recovery rate amongst patients with severe depression.

Methods

We made a secondary sub-sample analysis of data from patients with unipolar depression (N = 171) within a pragmatic, non-inferiority, randomized controlled clinical trial comparing two cognitive behavior therapy (CBT) group interventions. The treatment consisted of 14 2-hours weekly group CBT sessions. We collected depression PROMs with the Becks Depression Inventory-II and functional levels PROMs with the Work and Social Adjustment Scale at baseline, end-of-treatment, and at a 6-months follow-up.

Results

At follow-up, 35% (N = 43/123) of cases with moderate or severe depression (BDI > 19) at baseline reached scores below the cut-off for moderate depression. Recovery rates in severe cases were significantly lower (26.5 vs 52.5%; p = 0.0004). We observed severe functional impairment in 36% of the patients at baseline (52/144) and observed no changes or worsening in scores at a 6-months follow-up in 44% of the patients (64/144).

Conclusion

We achieved satisfactory remission rates for patients with moderate depression. Patients with severe depression and patients with functional impairment reached recovery rates below the standard of comparable MHSs. Improved MHSs for these patients are needed.

Keywords:

• Major depressive disorder
• cognitive behavioral therapy
• outpatients
• Jacobson plot
• case-ness
• recovery
• quality assurance

Acknowledgements

The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Author contributions

Dr. Arnfred had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: á Steig, Arnfred, Reinholt. Acquisition, analysis, or interpretation of data: All Authors. Drafting of the manuscript: á Steig, Arnfred. Critical revision of the manuscript for important intellectual content: All authors. Statistical analyses: á Steig, Arnfred. Study supervision: Arnfred. Obtaining funding: Arnfred.

Disclosure statement

No potential conflict of interest was reported by the author(s). Psychiatric Hospital West, Slagelse, Region Zealand Mental Health Services, Slagelse, Denmark (Arnfred, Reinholt, Bryde Christensen); Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark (á Steig, Arnfred); Mental Health Centre, Ballerup, Copenhagen University Hospital, Mental Health Service Capital Region, Ballerup Denmark. (Hvenegaard).

Additional information

Funding

This study was funded by [grant ID 114241] from TrygFonden [grant 5577 and 6215] from Jascha Fonden [grant RSSF2017-000667, RSSF2016-000342, and RSSF2015-000342] from Region Zealand Research Foundation; Ph.D. stipendium (Bryde Christensen) from Region Zealand Mental Health Services; Ph.D. Stipendium (Reinholt) from Mental Health Services Capital Region of Denmark.

Notes on contributors

Dávid Húsdal á Steig

David Husdal a Steig is 6th year medical student University of Copenhagen, having completed his clerkship in psychiatry and his master thesis in Psychiatry West, Slagelse.

Nina Reinholt

Nina Reinholt is PhD, clinical psychologist, specialist and supervisor of CBT and Danish expert in transdiagnostic CBT. She is senior researcher in Psychiatry West, Slagelse, and Head of the theme-based collaboration between psychotherapeutic units in the Mental Health Service Region Zealand.

Anne Bryde Christensen

Anne Bryde Christensen is PhD, clinical psychologist and senior researcher in Psychiatry West, Slagelse, carrying out qualitative psychotherapy research.

Morten Hvenegaard Pedersen

Morten Hvenegaard Pedersen, is PhD, clinical psychologist and senior researcher at Mental Health Center Ballerup, the Capital Region. He has participated in several large Danish group therapy trials.

Sidse Marie Arnfred

Sidse Marie Arnfred is Clinical Professor of Psychiatry with special focus on psychotherapy research, University of Copenhagen. She is CBT specialist and supervisor and Head of Research, Mental Health Service Region Zealand.