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Correlation between mental health comorbidity screening scores and clinical response in collaborative care treatment for depression

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The hypothesis for this paper is that adult patients who have higher screening scores for mental health co-morbidities and depression have a greater likelihood of not responding to treatment with collaborative care management (CCM) for their depression within six months.

For the 334 patients in this study, the primary endpoints were if the patient was in remission at six months (PHQ-9 score <5) or if they were non-responsive (NR) (PHQ-9 >50% of baseline score). Initial evaluation included screening for alcoholism (AUDIT), anxiety (GAD-7) and bipolar disorders (MDQ).

The differences in marital status, percentage of minority patients, gender, initial PHQ-9 and AUDIT scores were not statistically significant. Mood Disorders Questionnaire (MDQ) screening was more likely to be negative for the group in remission (96.2% vs 90.0%, P=0.049) and positive for the NR group (8.0% vs 2.1%, P=0.026). GAD-7 screening was significantly lower in the remission group (9.85) than in the NR group (11.53, P=0.009).

Results of multiple logistic regression analysis demonstrated that age, gender, race, marital status, PHQ-9 score and AUDIT score were not related to the odds of being NR. A one-point higher GAD-7 score was associated with approximately 6% higher adjusted odds of being NR. Patients with a positive MDQ were associated with elevated odds of non-response (adjusted OR=3.4714, P=0.044) when controlling for all other variables.

A higher initial screening score for anxiety or bipolar disorder is associated with a statistically significant increase in the relative risk of patients in CCM not responding to current treatments for depression within six months.


Document Type: Research Article

Affiliations: 1: Consultant and Assistant Professor of Family Medicine, Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA 2: Consultant and Assistant Professor of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA 3: Professor of Family Medicine, Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA

Publication date: September 1, 2010

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