Measuring Response to Adjunctive Therapy Among Individuals with Major Depressive Disorder

Figures & data

Figure 1 Flow Diagram of the Selection of Study Participants.

Table 1 Demographic Characteristics and Comorbidities Among Eligible Participants with MDD and ≥PHQ-9 Score During the 18-Month Study Period

		Total Population
		N=2389
		n	%
Gender	Female	1,792	75.0%
	Male	597	25.0%
Age, in years (mean, SD)		(48.2)	(13.4)
	18–30	274	11.5%
	31–49	877	36.7%
	50–64	1,084	45.4%
	≥65	154	6.4%
Insurance	Commercial	1,701	71.2%
	Medicaid	688	28.8%
Adjunctive Therapy	Psychotherapy	303	12.7%
	Pharmacotherapy	1,955	81.8%
	Both	131	5.5%
Available PHQ-9 scores	Baseline only	689	28.8%
	Follow-up only	979	41.0%
	Baseline and follow up	721	30.2%
Most recent MDD diagnosis prior to index by MDD severity	Unspecified	1,471	61.6%
	Severe	247	10.3%
	Moderate	545	22.8%
	Mild/In remission	126	5.3%
Psychiatric	GAD	1,259	52.7%
Comorbidities	Panic attacks/disorder	113	4.7%
	PTSD	149	6.2%
	Dysthymic disorder	114	4.8%
	Insomnia	489	20.5%
	Alcohol-related disorders	147	6.2%
	Substance-related disorders	592	24.8%
Medical comorbidities	Hypertension	1,010	42.3%
	Hyperlipidemia	1,010	42.3%
	Lower Back Pain	933	39.1%
	Obesity	882	36.9%
	COPD	592	24.8%
	Fatigue	554	23.2%
	Osteoarthritis	483	20.2%
	Diabetes	435	18.2%
	Asthma	340	14.2%
	Anemia	307	12.9%

Table 2 Baseline and Lowest Follow-Up PHQ-9 Scores Following Adjunctive Therapy Among the 721 Individuals with Scores in Both Periods

		Follow-Up PHQ-9
		None/ Minimal	Mild	Moderate	Moderately Severe	Severe
Baseline PHQ-9	None/Minimal	121	28	4	1	1
	Mild	79	65	22	10	2
	Moderate	52	51	36	17	3
	Moderately-severe	29	34	43	25	12
	Severe	14	22	14	20	16

Note: PHQ-9 score did not improve between baseline and follow up.

Figure 2 Distribution of the Lowest Severity Level Achieved^ǂ after at least One Month on Adjunctive Therapy, by the Type of Adjunctive Therapy Initiated.^ǂSeverity defined by categorized PHQ-9 score: 0 to 4 (none/minimal disease); 5–9 (mild), 10–14 (moderate), 15–19 (moderately severe), and 20–27 (severe).

Table 3 HEDIS Performance Among Individuals with a Baseline PHQ-9 Score of 10+

	Commercial			Medicaid
	(n=488)			(n=256)
	N	%	95% CI	N	%	95% CI
PHQ-9 4–8 months later	155	31.8%	(27.8–36.0)	73	28.5%	(23.2–34.0)
PHQ-9 <5	26	16.8%	(11.6–23.2)	10	13.7%	(6.8–21.9)
≥50% Reduction	60	38.7%	(31.6–47.1)	15	20.5%	(12.3–30.1)