Identifying Remission From Depression on 3 Self-Report Scales

Abstract

Advocates of measurement-based care approaches toward treatment recommend the use of self-report questionnaires. Many self-report scales have been developed to measure the severity of depression. Because of the significance accorded remission by experts, it is important to compare different scales in their identification of remitted patients. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared 3 self-report scales that assess the criteria for major depression in the identification of remission in patients treated in routine practice. From June 2011 to November 2012, 153 depressed outpatients with DSM-IV major depressive disorder completed the Clinically Useful Depression Outcome Scale (CUDOS), Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR), and Patient Health Questionnaire (PHQ-9). The patients were considered to be in remission according to the cutoff scores recommended by each scale's developers. The patients were also rated on the 17-item Hamilton Depression Rating Scale (HDRS). When the HDRS was used as the "gold standard" definition of remission, the CUDOS had the highest sensitivity for detecting remission (87%) and the QIDS-SR the highest specificity (97%). Overall, though, the level of agreement between the 3 self-report scales and HDRS in determining remission was approximately the same (79%-84%). The rate of remission was significantly higher on the HDRS compared to the QIDS-SR (35% vs 23%, McNemar P < .001), significantly lower than the rate on the CUDOS when a cutoff score of 19 was used (35% vs 47%, McNemar P < .001), and not significantly different from the rate on the PHQ-9 (31%) or the CUDOS when a cutoff score of 10 was used (34%). There are significant differences between standardized scales in determining remission from depression. It is important for the developers of depression measures to empirically derive cutoff scores that define important constructs such as remission.