The University of Southampton
University of Southampton Institutional Repository

Depression follow-up monitoring with the PHQ-9: open cluster-randomised controlled trial: an open cluster-randomised controlled trial

Depression follow-up monitoring with the PHQ-9: open cluster-randomised controlled trial: an open cluster-randomised controlled trial
Depression follow-up monitoring with the PHQ-9: open cluster-randomised controlled trial: an open cluster-randomised controlled trial

Background: outcome monitoring of depression is recommended but lacks evidence of patient benefit in primary care.

Aim: to test monitoring depression using the PHQ-9 questionnaire with patient feedback.

Design and setting: open cluster-randomised controlled trial in 141 group practices.

Method: adults with new depressive episodes were recruited through records searches and opportunistically.

Exclusion criteria: dementia, psychosis, substance misuse, suicide risk. The PHQ-9 questionnaire was to be administered soon after diagnosis, and 10-35 days later.

Primary outcome: Beck Depression Inventory (BDI-II) score at 12 weeks.

Secondary outcomes: BDI-II at 26 weeks; Work and Social Adjustment Scale and EuroQol EQ-5D-5L quality of life at 12 and 26 weeks; antidepressant treatment, mental health service use, adverse events, and Medical Informant Satisfaction Scale over 26 weeks.

Results: 302 intervention arm patients were recruited and 227 controls. At 12 weeks 252 (83.4%) and 195 (85.9%) were followed-up respectively. Only 41% of intervention arm patients had a GP follow-up PHQ-9 recorded. There was no significant difference in BDI-II score at 12 weeks (mean difference -0.46; 95% CI -2.16,1.26), adjusted for baseline depression, baseline anxiety, sociodemographic factors, and clustering by practice). EQ-5D-5L quality of life scores were higher in the intervention arm at 26 weeks (adjusted mean difference 0.053; 95% CI 0.093,0.013). A clinically significant difference in depression at 26 weeks could not be ruled out. No significant differences were found in social functioning, adverse events, or satisfaction. In a per-protocol analysis, antidepressant use and mental health contacts were significantly greater in intervention arm patients with a recorded follow-up PHQ-9.

Conclusions: no evidence was found of improved depression outcome at 12 weeks from monitoring. The findings of possible benefits over 26 weeks warrant replication, investigating possible mechanisms, preferably with automated delivery of monitoring and more instructive feedback.

Adult, Antidepressive Agents/therapeutic use, Depression/diagnosis, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Health Questionnaire, Primary Health Care, Psychiatric Status Rating Scales, Quality of Life, mental health, mood disorders, primary health care, patient reported outcome measures, depression
0960-1643
e456-e465
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Dowrick, Christopher
1869ad5e-1959-446c-b2a8-3fcdf3e79667
Lewis, Glyn
64d33857-c138-4d24-96c9-f91219acce46
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Geraghty, Adam W.A.
2c6549fe-9868-4806-b65a-21881c1930af
Griffiths, Gareth
7fd300c0-d279-4ff6-842d-aa1f2b9b864d
Zhu, Shihua
13511f9c-151c-483c-9dfd-2da13421db5c
Yao, Guiqing
69edb606-fc8b-4e3f-b38f-d2196f976b6f
May, Carl
eb69c0ab-18f0-42d0-a147-8987fcf26844
Gabbay, Mark
841e8b5a-5d9d-40fd-94eb-734b398baf2a
Dewar-Haggart, Rachel
7ae70377-352a-4297-9798-a6aed0e1c04b
Williams, Samantha
833280ea-61f5-4263-af2d-a4c8c3cd74d6
Bui, Lien
ce7d43eb-4f15-4b3e-9e4b-4e54ade33fe5
Thompson, Natalie
f2803da0-85a3-456a-98d0-3b09b3adf9ef
Bridewell, Lauren
e2261ec6-117c-4573-a95b-247459352d47
Trapasso, Emilia
1cd3f667-7929-4d35-82d2-2fd0f3966727
Patel, Tasneem
de599aa2-bfd4-418d-9035-bd876e90b1e0
McCarthy, Molly
475ad5d7-3ff8-455b-bed7-610b3e510a2a
Khan, Naila
ca15e7ab-7c2b-4778-a25e-92cc84aaeec1
Page, Helen
7e8cf556-967b-41e1-9eb0-f193df02f57b
Corcoran, Emma
7d1650f9-a145-4b49-8cb0-d675d96c2833
Hahn, Jane Sungmin
c677a074-b326-448c-9657-f01480e4e2e7
Bird, Molly
feff531c-b7d7-4971-a01b-469604a77403
Logan, Mekeda X.
43a14d2e-81a2-4290-ba8b-2defc87b88ac
Ching, Brian Chi Fung
33e57b38-959d-4a1a-977a-0560ea16fa54
Tiwari, Riya
53ff8225-19ce-42e8-82a1-9d07f0a7b304
Hunt, Anna
2b20e8b2-38b3-4b74-a8e0-3c21c7c354cd
Stuart, Beth
530c66bd-5dc1-48d8-bff5-4b9b7774aba3
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Dowrick, Christopher
1869ad5e-1959-446c-b2a8-3fcdf3e79667
Lewis, Glyn
64d33857-c138-4d24-96c9-f91219acce46
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Geraghty, Adam W.A.
2c6549fe-9868-4806-b65a-21881c1930af
Griffiths, Gareth
7fd300c0-d279-4ff6-842d-aa1f2b9b864d
Zhu, Shihua
13511f9c-151c-483c-9dfd-2da13421db5c
Yao, Guiqing
69edb606-fc8b-4e3f-b38f-d2196f976b6f
May, Carl
eb69c0ab-18f0-42d0-a147-8987fcf26844
Gabbay, Mark
841e8b5a-5d9d-40fd-94eb-734b398baf2a
Dewar-Haggart, Rachel
7ae70377-352a-4297-9798-a6aed0e1c04b
Williams, Samantha
833280ea-61f5-4263-af2d-a4c8c3cd74d6
Bui, Lien
ce7d43eb-4f15-4b3e-9e4b-4e54ade33fe5
Thompson, Natalie
f2803da0-85a3-456a-98d0-3b09b3adf9ef
Bridewell, Lauren
e2261ec6-117c-4573-a95b-247459352d47
Trapasso, Emilia
1cd3f667-7929-4d35-82d2-2fd0f3966727
Patel, Tasneem
de599aa2-bfd4-418d-9035-bd876e90b1e0
McCarthy, Molly
475ad5d7-3ff8-455b-bed7-610b3e510a2a
Khan, Naila
ca15e7ab-7c2b-4778-a25e-92cc84aaeec1
Page, Helen
7e8cf556-967b-41e1-9eb0-f193df02f57b
Corcoran, Emma
7d1650f9-a145-4b49-8cb0-d675d96c2833
Hahn, Jane Sungmin
c677a074-b326-448c-9657-f01480e4e2e7
Bird, Molly
feff531c-b7d7-4971-a01b-469604a77403
Logan, Mekeda X.
43a14d2e-81a2-4290-ba8b-2defc87b88ac
Ching, Brian Chi Fung
33e57b38-959d-4a1a-977a-0560ea16fa54
Tiwari, Riya
53ff8225-19ce-42e8-82a1-9d07f0a7b304
Hunt, Anna
2b20e8b2-38b3-4b74-a8e0-3c21c7c354cd
Stuart, Beth
530c66bd-5dc1-48d8-bff5-4b9b7774aba3

Kendrick, Tony, Dowrick, Christopher, Lewis, Glyn, Moore, Michael, Leydon, Geraldine, Geraghty, Adam W.A., Griffiths, Gareth, Zhu, Shihua, Yao, Guiqing, May, Carl, Gabbay, Mark, Dewar-Haggart, Rachel, Williams, Samantha, Bui, Lien, Thompson, Natalie, Bridewell, Lauren, Trapasso, Emilia, Patel, Tasneem, McCarthy, Molly, Khan, Naila, Page, Helen, Corcoran, Emma, Hahn, Jane Sungmin, Bird, Molly, Logan, Mekeda X., Ching, Brian Chi Fung, Tiwari, Riya, Hunt, Anna and Stuart, Beth (2024) Depression follow-up monitoring with the PHQ-9: open cluster-randomised controlled trial: an open cluster-randomised controlled trial. The British journal of general practice : the journal of the Royal College of General Practitioners, 74 (744), e456-e465. (doi:10.3399/BJGP.2023.0539).

Record type: Article

Abstract

Background: outcome monitoring of depression is recommended but lacks evidence of patient benefit in primary care.

Aim: to test monitoring depression using the PHQ-9 questionnaire with patient feedback.

Design and setting: open cluster-randomised controlled trial in 141 group practices.

Method: adults with new depressive episodes were recruited through records searches and opportunistically.

Exclusion criteria: dementia, psychosis, substance misuse, suicide risk. The PHQ-9 questionnaire was to be administered soon after diagnosis, and 10-35 days later.

Primary outcome: Beck Depression Inventory (BDI-II) score at 12 weeks.

Secondary outcomes: BDI-II at 26 weeks; Work and Social Adjustment Scale and EuroQol EQ-5D-5L quality of life at 12 and 26 weeks; antidepressant treatment, mental health service use, adverse events, and Medical Informant Satisfaction Scale over 26 weeks.

Results: 302 intervention arm patients were recruited and 227 controls. At 12 weeks 252 (83.4%) and 195 (85.9%) were followed-up respectively. Only 41% of intervention arm patients had a GP follow-up PHQ-9 recorded. There was no significant difference in BDI-II score at 12 weeks (mean difference -0.46; 95% CI -2.16,1.26), adjusted for baseline depression, baseline anxiety, sociodemographic factors, and clustering by practice). EQ-5D-5L quality of life scores were higher in the intervention arm at 26 weeks (adjusted mean difference 0.053; 95% CI 0.093,0.013). A clinically significant difference in depression at 26 weeks could not be ruled out. No significant differences were found in social functioning, adverse events, or satisfaction. In a per-protocol analysis, antidepressant use and mental health contacts were significantly greater in intervention arm patients with a recorded follow-up PHQ-9.

Conclusions: no evidence was found of improved depression outcome at 12 weeks from monitoring. The findings of possible benefits over 26 weeks warrant replication, investigating possible mechanisms, preferably with automated delivery of monitoring and more instructive feedback.

Text
BJGP.2023.0539.full - Accepted Manuscript
Available under License Creative Commons Attribution.
Download (673kB)

More information

Accepted/In Press date: 19 February 2024
e-pub ahead of print date: 27 June 2024
Published date: 1 July 2024
Keywords: Adult, Antidepressive Agents/therapeutic use, Depression/diagnosis, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Health Questionnaire, Primary Health Care, Psychiatric Status Rating Scales, Quality of Life, mental health, mood disorders, primary health care, patient reported outcome measures, depression

Identifiers

Local EPrints ID: 488079
URI: http://eprints.soton.ac.uk/id/eprint/488079
ISSN: 0960-1643
PURE UUID: 4c7d0972-f748-43ea-9d63-a7a0689445a2
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Geraldine Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Adam W.A. Geraghty: ORCID iD orcid.org/0000-0001-7984-8351
ORCID for Gareth Griffiths: ORCID iD orcid.org/0000-0002-9579-8021
ORCID for Rachel Dewar-Haggart: ORCID iD orcid.org/0000-0002-3757-1152
ORCID for Lien Bui: ORCID iD orcid.org/0000-0003-3434-4066

Catalogue record

Date deposited: 14 Mar 2024 18:49
Last modified: 18 Oct 2024 01:46

Export record

Altmetrics

Contributors

Author: Tony Kendrick ORCID iD
Author: Christopher Dowrick
Author: Glyn Lewis
Author: Michael Moore ORCID iD
Author: Shihua Zhu
Author: Guiqing Yao
Author: Carl May
Author: Mark Gabbay
Author: Samantha Williams
Author: Lien Bui ORCID iD
Author: Natalie Thompson
Author: Lauren Bridewell
Author: Emilia Trapasso
Author: Tasneem Patel
Author: Molly McCarthy
Author: Naila Khan
Author: Helen Page
Author: Emma Corcoran
Author: Jane Sungmin Hahn
Author: Molly Bird
Author: Mekeda X. Logan
Author: Brian Chi Fung Ching
Author: Riya Tiwari
Author: Anna Hunt
Author: Beth Stuart

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×