TY - JOUR
T1 - The utility of PHQ-9 and CGI-S in measurement-based care for predicting suicidal ideation and behaviors
AU - Glazer, Kara
AU - Rootes-Murdy, Kelly
AU - Van Wert, Michael
AU - Mondimore, Francis
AU - Zandi, Peter
N1 - Funding Information:
This work was made possible by a research collaboration supported by the National Network of Depression Centers (NNDC), an inter-dependent nonprofit consortium of 26 academic depression centers. We utilized real world longitudinal data from the NDDC clinical care registry (CCR), a measurement-based care registry of patients affiliated with the NNDC. Work on the NNDC CCR was supported by a CTSA grant award UL1TR000433 to the University of Michigan. This work used data from the CCR on patients from the following ten NNDC sites: Duke University, Emory University, Johns Hopkins University, Mayo Clinic, Stanford University, University of Illinois at Chicago, University of Iowa, University of Massachusetts, University of Pennsylvania, and Harvard Brigham & Women's Hospital. We would like to thank the patients and providers of these sites. We would also like to thank the NNDC Executive Director, Pat Rinvelt, for her assistance with data sharing and coordination.
Funding Information:
This work was made possible by a research collaboration supported by the National Network of Depression Centers (NNDC), an inter-dependent nonprofit consortium of 26 academic depression centers. We utilized real world longitudinal data from the NDDC clinical care registry (CCR), a measurement-based care registry of patients affiliated with the NNDC. Work on the NNDC CCR was supported by a CTSA grant award UL1TR000433 to the University of Michigan. This work used data from the CCR on patients from the following ten NNDC sites: Duke University, Emory University, Johns Hopkins University, Mayo Clinic, Stanford University, University of Illinois at Chicago, University of Iowa, University of Massachusetts, University of Pennsylvania, and Harvard Brigham & Women's Hospital. We would like to thank the patients and providers of these sites. We would also like to thank the NNDC Executive Director, Pat Rinvelt, for her assistance with data sharing and coordination.
Publisher Copyright:
© 2018
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: Measurement-based care (MBC) has emerged as an effective strategy for improving outcomes in patients with mood disorders. Suicide is a particularly devastating outcome of mood disorders. Using data from a new MBC program from the National Network of Depression Centers (NNDC), we examined whether capturing a patient-rated symptom measure, the patient health questionnaire (PHQ-9), along with a provider-rated global functioning measure, the clinical global impression scale (CGI-S), improves identification of patients at risk of suicide over using either measure alone. Methods: A total of 126 adults with mood disorders from nine sites in the NNDC completed the PHQ-9 and CGI-S and had at least one subsequent visit where they completed the Columbia-suicide severity rating scale (C-SSRS). The PHQ-9 (≥10) and CGI-S (≥4) were dichotomized at commonly accepted severity thresholds. Associations of the PHQ-9 and CGI-S with suicidal ideation or behavior were examined using Firth's logistic regression to accommodate small samples while controlling for age, sex, race, and diagnosis. Results: Patients who scored higher on only the PHQ-9 or CGI-S were not significantly more likely to experience subsequent suicidal ideation or behaviors. However, patients who scored higher on both the PHQ-9 and CGI-S were significantly more likely to experience suicidal ideation (OR = 4.70, p = 0.0005) and suicidal behaviors (OR = 25.38, p = 0.0003). Discussion: Information from both patient and clinician-rated measures was better able to identify patients with mood disorders at risk for suicidal ideation and behaviors. Using both together may help reduce the risk of suicide by identifying those patients at greatest risk and allowing for more targeted interventions.
AB - Background: Measurement-based care (MBC) has emerged as an effective strategy for improving outcomes in patients with mood disorders. Suicide is a particularly devastating outcome of mood disorders. Using data from a new MBC program from the National Network of Depression Centers (NNDC), we examined whether capturing a patient-rated symptom measure, the patient health questionnaire (PHQ-9), along with a provider-rated global functioning measure, the clinical global impression scale (CGI-S), improves identification of patients at risk of suicide over using either measure alone. Methods: A total of 126 adults with mood disorders from nine sites in the NNDC completed the PHQ-9 and CGI-S and had at least one subsequent visit where they completed the Columbia-suicide severity rating scale (C-SSRS). The PHQ-9 (≥10) and CGI-S (≥4) were dichotomized at commonly accepted severity thresholds. Associations of the PHQ-9 and CGI-S with suicidal ideation or behavior were examined using Firth's logistic regression to accommodate small samples while controlling for age, sex, race, and diagnosis. Results: Patients who scored higher on only the PHQ-9 or CGI-S were not significantly more likely to experience subsequent suicidal ideation or behaviors. However, patients who scored higher on both the PHQ-9 and CGI-S were significantly more likely to experience suicidal ideation (OR = 4.70, p = 0.0005) and suicidal behaviors (OR = 25.38, p = 0.0003). Discussion: Information from both patient and clinician-rated measures was better able to identify patients with mood disorders at risk for suicidal ideation and behaviors. Using both together may help reduce the risk of suicide by identifying those patients at greatest risk and allowing for more targeted interventions.
KW - Measurement-based care
KW - Mood disorder
KW - Suicide
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U2 - 10.1016/j.jad.2018.05.054
DO - 10.1016/j.jad.2018.05.054
M3 - Article
C2 - 29954612
AN - SCOPUS:85048980034
SN - 0165-0327
VL - 266
SP - 766
EP - 771
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -