Clinically Useful Depression Outcome Scale Research Articles

How Can We Use Depression Severity to Guide Treatment Selection When Measures of Depression Categorize Patients Differently?

Treatment guidelines for depression suggest that severity should be taken into account when initiating treatment. If clinicians are to consider illness severity in selecting among treatment options for depression, then it is important to have reliable, valid, and clinically useful methods of distinguishing between levels of depression severity. 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 DSM-IV criteria for major depressive disorder on the basis of how these scales distribute patients into severity categories. From June 2010 to November 2011, 245 depressed outpatients completed the Clinically Useful Depression Outcome Scale (CUDOS), Quick Inventory of Depressive Symptomatology (QIDS), and Patient Health Questionnaire (PHQ-9). The study was conducted at Rhode Island Hospital, Providence, Rhode Island. The patients were subdivided into severity categories according to the cutoff scores recommended by each scales' developers. The patients were also rated on the 17-item Hamilton Depression Rating Scale (HDRS-17). The correlations between the HDRS-17 and the 3 self-report scales were nearly identical. Yet the scales significantly differed in their distribution of patients into severity categories. On the CUDOS and HDRS-17, moderate depression was the most frequent severity category, whereas on the PHQ-9 and QIDS, the majority of the patients were classified as severe. Significantly fewer patients were classified as severely depressed on the CUDOS compared to the PHQ-9 (McNemar = 153.8; P < .001) and QIDS (McNemar = 114.0; P < .001). If clinicians are to follow treatment guidelines' recommendations to base initial treatment selection on the severity of depression, then it is important to have a consistent method of determining depression severity. The marked disparity between standardized scales in the classification of depressed outpatients into severity groups indicates that there is a problem with the use of such instruments to classify depression severity. Caution is warranted in the use of these scales to guide treatment selection until the thresholds to define severity ranges have been empirically established.

How should residual symptoms be defined in depressed patients who have remitted?

Symptomatic remission has been defined as a complete or near-complete absence of symptoms. Just as the distinction between remitters and nonremitters among treatment responders has clinical significance, the distinction between a complete and near-complete absence of symptoms itself might be important. Recent studies have reported a high frequency of residual symptoms in patients who are presumably in remission, and this raises questions about how residual symptoms are defined. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we compared the prevalence of residual symptoms based on different cutoff scores on 2 self-report measures of depression and then determined the association between residual symptoms and indices of psychosocial morbidity. We administered the 17-item Hamilton Rating Scale for Depression to 274 psychiatric outpatients diagnosed as having DSM-IV major depressive disorder who were in ongoing treatment. The patients completed the Clinically Useful Depression Outcome Scale (CUDOS) and Quick Inventory of Depressive Symptomatology (QIDS) and measures of psychosocial functioning and quality of life. We examined the frequency of residual symptoms in the 142 patients scoring in the remission range on the Hamilton Rating Scale for Depression. For both the CUDOS and QIDS, the threshold to define symptom presence strongly impacted on the prevalence of residual symptoms. The association between residual symptoms, psychosocial functioning, and quality of life varied according to the threshold used to define the symptoms. On the QIDS, a cutoff of 1 was a more valid indicator of the presence of residual symptoms than a cutoff of 2, whereas on the CUDOS, we recommend a cutoff of 2 be used to indicate the presence of residual symptoms. Examination of the frequency of specific symptoms suggests that the choice of scale might impact on which residual symptoms are considered the most frequent in treatment remitters.

Determining remission from depression on two self-report symptom scales: a comparison of the Quick Inventory of Depressive Symptomatology and the Clinically Useful Depression Outcome Scale

To answer fundamental questions regarding the effectiveness of treatments for depression in real-world clinical practice, it is necessary to incorporate the measurement of outcome. Self-report questionnaires are a cost-effective option to systematically, reliably, and validly evaluate clinical status because they are inexpensive in terms of professional time needed for administration, and do not require special training for administration. While there are many self-administered depression scales, only a limited number cover all of the diagnostic criteria for major depressive disorder (MDD) and have had cutoff scores derived corresponding to the Hamilton Depression Rating Scale (HAM-D) definition of remission. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we compared 2 scales in their respective ability to identify remission as defined by the HAM-D. We administered the 17-item HAM-D to 274 depressed outpatients in ongoing treatment. The patients completed the Quick Inventory of Depressive Symptomatology (QIDS) and the Clinically Useful Depression Outcome Scale (CUDOS). Based on the cutoffs recommended by the developers of the scales to identify remission, the 2 scales performed similarly overall though the sensitivity was higher for the QIDS than the CUDOS (95.5% vs. 78.7%), whereas specificity was higher for the CUDOS than the QIDS (73.0% vs. 50.0%). On the CUDOS, the cutoff that maximized the sum of sensitivity and specificity was similar to cutoff initially derived for this purpose; however, for the QIDS, the optimal cutoff was higher than the cutoff originally derived for this purpose. In conclusion, the CUDOS and the QIDS were equally highly related to the HAM-D definition of remission. The CUDOS takes less time to complete than the QIDS and, therefore, may be preferable to use in routine clinical practice.

Web-Based Assessment of Depression in Patients Treated in Clinical Practice

Calls for the use of standardized assessments in clinical practice have been increasing. A Web-based administration of outcome assessments offers several potential advantages over paper-and-pencil assessments, such as patient convenience, reduced missing data, reduced costs, automatic scoring, and generation of large databases. The present study from the Rhode Island Methods to Improve Diagnostic Assessments and Services (MIDAS) project evaluated the acceptability, reliability, and validity of a Web-based administration of a depression scale in patients receiving ongoing care for depression. From June 2009 to July 2010, fifty-three depressed outpatients completed a Web-based and a paper version of the Clinically Useful Depression Outcome Scale (CUDOS). The vast majority of patients met DSM-IV criteria for either major depressive disorder (n = 36) or bipolar disorder (n = 9). Patients were also asked to complete a brief 6-question survey of the acceptability of the 2 modes of scale administration. At the time of the visit, the patients' psychiatrist completed the Montgomery-Asberg Depression Rating Scale (MADRS) and rated patients on the Clinical Global Impressions-Severity of Illness (CGI-S) scale and Global Assessment of Functioning (GAF). The correlation between the Web-administered and paper versions of the CUDOS was high (P < .001). The mean scores were similar on the paper and Internet administrations. The internal consistency of the paper and Internet administrations of the CUDOS was high (both values, Cronbach α = .93), and all item-scale correlations for the paper and Internet versions were significant (median for paper administration = 0.76; median for Internet administration = 0.74). The paper and Internet versions of the CUDOS were equally correlated with clinicians' ratings on the MADRS, CGI-S, and GAF (all P values < .001). Patients reported high levels of satisfaction with Internet administration and preferred this method of monitoring outcome to paper administration in the office (all P values < .001). The results of this first study of the use of a Web-based system of monitoring outcome in routine clinical practice supported the reliability and validity of Internet administration of a depression scale, and patients clearly preferred Internet administration to completion of a paper-and-pencil questionnaire in the office.

Depressed Patients' Acceptability of the Use of Self-Administered Scales to Measure Outcome in Clinical Practice

Self-report questionnaires are a cost-effective option to monitor the outcome of clinical care. Even when using self-report scales, consideration should be given to how much time they take to complete and how burdensome they are perceived to be. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the acceptability of completing two depression scales-the Beck Depression Inventory (BDI) and the Clinically Useful Depression Outcome Scale (CUDOS). In the first study, 50 depressed psychiatric outpatients completed the CUDOS and a questionnaire assessing how burdensome it was to complete during the visit. In the second study, a separate sample of 50 depressed outpatients completed the CUDOS and BDI and a measure of scale acceptability. Almost all patients completed the CUDOS in less than 3 minutes (mean = 102.7 seconds, SD = 42.7) and considered the questionnaire very little or a little burdensome (98.0%, n = 49). In the second study comparing the CUDOS and the BDI, significantly more patients indicated that the CUDOS took less time to complete and was less of a burden to complete. Nearly three times as many patients indicated that they would prefer to complete the CUDOS in order to monitor the outcome of treatment (40.0% vs. 14.0%, z = 2.31, p .05). A consumer-friendly, reliable, and valid self-administered questionnaire can improve the efficiency of the clinical encounter. The brevity of the CUDOS lends itself to regular administration in clinical practice.

A clinically useful depression outcome scale

If the optimal delivery of mental health treatment ultimately depends on examining outcome, then precise, reliable, valid, informative, and user-friendly measurement is the key to evaluating the quality and efficiency of care in clinical practice. Self-report questionnaires are a cost-effective option because they are inexpensive in terms of professional time needed for administration, and they correlate highly with clinician ratings. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we describe the reliability and validity of the Clinically Useful Depression Outcome Scale (CUDOS). The CUDOS was designed to be brief (completed in less than 3 minutes), quickly scored (in less than 15 seconds), clinically useful (fully covering the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptoms of major depressive disorder and dysthymic disorder), reliable, valid, and sensitive to change. We studied the CUDOS in more than 1400 psychiatric outpatients and found that the scale had high internal consistency and test-retest reliability. The CUDOS was more highly correlated with another self-report measure of depression than with measures of anxiety, substance use problems, eating disorders, and somatization, thereby supporting the convergent and discriminant validity of the scale. The CUDOS was also highly correlated with interviewer ratings of the severity of depression, and CUDOS scores were significantly different in depressed patients with mild, moderate, and severe levels of depression. The CUDOS was a valid measure of symptom change. Finally, the CUDOS was significantly associated with a diagnosis of major depressive disorder. Thus, the results of this large validation study of the CUDOS shows that it is a reliable and valid measure of depression that is feasible to incorporate into routine clinical practice.

La personnalité cyclothymique

Remission is usually defined as a score below a predetermined cutoff on a symptom severity scale. Depressed patients' global perception of their remission status only partially overlaps with scale-based definitions of remission. Patients' self-perceived remission status is likely to impact on their desire for modification in their treatment. The identification of specific symptoms that distinguish patients who do and do not consider themselves to be in remission could represent the most salient targets of add-on treatment strategies desired by patients. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the symptom profiles of patients who were in remission on the Hamilton Rating Scale for Depression (HAMD) who did and did not consider themselves to be in remission.We interviewed 274 psychiatric outpatients diagnosed with DSM-IV major depressive disorder who were in ongoing treatment. The patients completed the Clinically Useful Depression Outcome Scale (CUDOS).Approximately half of the patients scoring 7 and below on the HAMD did not consider themselves to be in remission. The mean number of symptoms on the CUDOS was significantly higher in the self-described non-remitters. Almost all symptoms were less frequent in the self-rated remitters, though the absolute frequency of the individual symptoms was related to the threshold used to define symptom presence.Consistent with the findings of other studies we found high rates of residual symptoms in patients who were considered to be in remission, and patients with residual symptoms typically had more than 1 such symptom. These results raise questions about the strategy of add-on treatments targeting specific individual symptoms.Remission was defined according to the 17-item version of the HAMD. We focused on the 17-item HAMD because it is the most commonly used measure in antidepressant efficacy trials, and the cutoff used to define remission has been generally accepted. We would anticipate that our findings would be similar in studies of longer versions of the HAMD as well as other depression severity scales such as the Montgomery–Asberg Depression Rating Scale. Self-perceived remission status was based on the patients' response to a single question. The sample was drawn from a single, large, general adult outpatient private practice setting in which the majority of the patients were white, female, and in their 30s and 40s. Generalizability to samples with different demographic characteristics needs to be demonstrated.

Differences Between Minimally Depressed Patients Who Do and Do Not Consider Themselves to Be in Remission

We recently derived a cutoff on a self-report scale corresponding to the most commonly used definition of remission in depression treatment studies (i.e., Hamilton Rating Scale for Depression [HAM-D] score < or = 7). However, recent research has suggested that use of this cutoff on the HAM-D to define remission is overinclusive. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine how many depressed patients in ongoing treatment who are considered to be in remission by a self-report equivalent of the HAM-D definition of remission nonetheless do not consider themselves to be in remission. Five hundred thirty-five psychiatric outpatients treated for a DSM-IV major depressive episode were asked whether they considered themselves to be in remission and completed the Clinically Useful Depression Outcome Scale (CUDOS), a measure of the severity of the DSM-IV symptoms of depression. The study was conducted from August 2003 until July 2004. Nearly one quarter of the patients who met the remission threshold on the CUDOS (55/249) did not consider themselves to be in remission. Among the CUDOS remitters, the total score on the CUDOS was significantly lower (p < .001) in patients who considered themselves to be in remission than in patients who did not indicate that they were in remission. Examination of specific symptoms revealed greater appetite disturbance and hypersomnia in the patients who did not think they were in remission. Our results suggest that heterogeneity of clinical status exists even among patients who are minimally depressed and considered to be in remission according to contemporary definitions on symptom severity scales.

P.1 .034 Efficacy of mirtazapine vs. SSRls in anxietysymptoms associated with major depression: A pooled data analysis

Remission is usually defined as a score below a predetermined cutoff on a symptom severity scale. Depressed patients' global perception of their remission status only partially overlaps with scale-based definitions of remission. Patients' self-perceived remission status is likely to impact on their desire for modification in their treatment. The identification of specific symptoms that distinguish patients who do and do not consider themselves to be in remission could represent the most salient targets of add-on treatment strategies desired by patients. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the symptom profiles of patients who were in remission on the Hamilton Rating Scale for Depression (HAMD) who did and did not consider themselves to be in remission.We interviewed 274 psychiatric outpatients diagnosed with DSM-IV major depressive disorder who were in ongoing treatment. The patients completed the Clinically Useful Depression Outcome Scale (CUDOS).Approximately half of the patients scoring 7 and below on the HAMD did not consider themselves to be in remission. The mean number of symptoms on the CUDOS was significantly higher in the self-described non-remitters. Almost all symptoms were less frequent in the self-rated remitters, though the absolute frequency of the individual symptoms was related to the threshold used to define symptom presence.Consistent with the findings of other studies we found high rates of residual symptoms in patients who were considered to be in remission, and patients with residual symptoms typically had more than 1 such symptom. These results raise questions about the strategy of add-on treatments targeting specific individual symptoms.Remission was defined according to the 17-item version of the HAMD. We focused on the 17-item HAMD because it is the most commonly used measure in antidepressant efficacy trials, and the cutoff used to define remission has been generally accepted. We would anticipate that our findings would be similar in studies of longer versions of the HAMD as well as other depression severity scales such as the Montgomery–Asberg Depression Rating Scale. Self-perceived remission status was based on the patients' response to a single question. The sample was drawn from a single, large, general adult outpatient private practice setting in which the majority of the patients were white, female, and in their 30s and 40s. Generalizability to samples with different demographic characteristics needs to be demonstrated.

Using a Self-Report Depression Scale to Identify Remission in Depressed Outpatients

OBJECTIVE: Some have suggested that standardized rating scales be used in clinical practice to monitor the course of treatment; however, the time demands of clinical practice make it difficult to use such measures. This study derived a cutoff on a self-report depression questionnaire corresponding to the most widely used definition of remission (a score ≤7 on the 17-item Hamilton Depression Rating Scale). METHOD: Two hundred sixty-seven depressed outpatients were rated on the Hamilton depression scale and completed the Clinically Useful Depression Outcome Scale (CUDOS). The authors used receiver operating curve analysis to examine the ability of the CUDOS to identify remission on the Hamilton depression scale. RESULTS: A high level of agreement was found between the self-report and Hamilton depression scale assessments of remission. CONCLUSIONS: Self-report questionnaires represent a practical option for thoroughly and objectively evaluating the course of treatment and determining remission in depressed patients.