Thursday, July 21, 2016

Self-Report Symptom Scale May Predict Patients Most Likely to Experience Depressive Relapse

Despite achieving full remission from depression, it is estimated that nearly 15% of formerly depressed patients may relapse within six months. A study published in AJP in Advance now suggests a 12-item symptom-based tool may be able to predict those at greatest risk of depressive relapse.

Lewis Judd, M.D., of the University of California, San Diego, and colleagues examined the records of participants in the National Institute of Mental Health Collaborative Depression Study. (As part of the NIMH study, follow-up evaluations were regularly conducted and patients periodically completed the Symptom Checklist–90 [SCL-90] self-report.) 

The researchers analyzed the records of 188 patients with major depressive disorder who had at least one SCL-90 assessment after at least eight weeks of full remission from a depressive episode (defined as a value of 1 on the weekly psychiatric rating scale for all depressive conditions, recorded on Longitudinal Follow-Up Evaluation interviews). 

In about 1 in 7 occasions when 188 remitted subjects completed the SCL-90 (73 of 514 assessments), relapse followed within the ensuing 6 months. Analysis of these SCL-90 reports revealed a broad range of symptoms present at a moderate or worse level, including dysphoria, sleep disturbances, somatization, and having one’s feelings easily hurt. 

Further analysis revealed a set of 12 symptoms that most accurately predicted relapse within six months. The relapse rate was 5.8% when none of the 12 symptoms were present, 16.4% when one to five symptoms were present, 34.1% when six to nine symptoms were present, and 72.7% when 10 or more symptoms were present.

“A simple count of the number of symptoms (0 to 12) self-reported at a moderate or worse level of severity during the past week created a score that was highly related to the risk of relapse,” Judd and colleagues wrote.

This study demonstrates “it is possible to construct a brief self-report scale that can be used to ascertain an estimated risk of relapse for the individual patient,” the authors continued. “Such a person-level indicator can be used to tailor the follow-up schedule for each remitted patient based on his or her individually identified risk of relapse and potentially to initiate interventions in a more timely fashion when needed.”

For related information, see the Psychiatric News article “Integrating CBT, Pharmacotherapy May Prevent Relapse in MDD.”

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