Early identification of treatment non-response utilizing the Patient Health Questionnaire (PHQ-9). (September 2015)

• Record Type: Journal Article
• Authors: Fowler, J. Christopher; Patriquin, Michelle; Madan, Alok; Allen, Jon G.; Frueh, B. Christopher; Oldham, John M.
• Is Part Of: Journal of psychiatric research. Volume 68(2015:Sep.)
• Page Start: 114
• Page End: 119
• Publication Date: 2015-09
• Subjects: PHQ-9 -- Prediction -- Treatment non-response -- Diagnostic efficiency; Psychiatry -- Periodicals; Mental Disorders -- Periodicals; Maladies mentales -- Périodiques; Psychiatry; Electronic journals; Periodicals; 616.89005
• DOI: 10.1016/j.jpsychires.2015.06.018
• Languages: English
• ISSNs: 0022-3956

Abstract

Abstract: Background: Treatment non-response among high-risk, psychiatric patients exposes those suffering to suicidal risk as well as persistent social and occupational difficulties. Strategies for identification of treatment non-response are limited. Aims: Diagnostic efficiency of a self-report, cross-cutting symptom measure was assessed as a marker of treatment non-response. Method: 835 inpatients at a specialist psychiatric hospital completed the Patient Health Questionnaire – Depression (PHQ-9) at admission and every two weeks during hospitalization. Results: For patients admitted with severe depression (PHQ-9 ≥ 20), results indicated good accuracy of 2-week PHQ-9 change score in identifying treatment non-response (AUC = 0.80, SE = 0.04, p < .0001; sensitivity = 85%; specificity = 73%; OR = 14.91). Conclusions: The search for predictors of non-response to psychiatric treatment has a long and generally unfulfilled history. The PHQ-9 change score holds promise as a cost-effective test with comparable diagnostic characteristics to other medical tests. Graphical abstract: Highlights: Treatment non-response negatively impacts approximately 50% of psychiatric patients. Early identification of probable non-response can lead to better clinical decisions. 2-week response to the PHQ-9 was assessed as a predictor of non-response. For those with severe depression, less than 7 point improvement in PHQ-9 predicts non-response.