New depression screening tool gauges progress

A new screening tool could help primary care physicians manage their depressed patients by evaluating how much an individual's condition has improved, according to new research by the developers of the test.

The study authors recommend that primary care physicians use the new Remission Evaluation and Mood Inventory Tool in conjunction with the widely administered nine-item Patient Health Questionnaire.

The PHQ-9 was developed by physicians who received a grant from Pfizer Inc. The questionnaire helps doctors diagnose depression in patients who might be presenting symptoms and select the appropriate treatment by gauging the extent of an individual's depression. For example, the PHQ-9 asks a patient how often in the last two weeks he or she has felt down, depressed or hopeless.

PHQ-9 measures improvement in symptoms by evaluating if patients are showing fewer of them, with less severity. REMIT is designed to measure positive aspects of a depressed patients' recovery, with questions about whether patients are feeling happy or in control. The research for this tool was partially supported by a grant from Eli Lilly & Co.

"These are all things people experience as they begin to recover," said lead study author Donald Nease Jr., MD, who helped develop the tool. The report was published in the May-June issue of General Hospital Psychiatry.

Depressed patients are typically considered to be in remission when they no longer have symptoms of the disease as detailed in the fourth edition of the Diagnostic and Statistical Manual of Disorders, Dr. Nease said.

Such symptoms include feelings of sadness or emptiness, reduced interest in activities that used to be enjoyed, sleep disturbances and loss of energy.

But he said primary care physicians sometimes find that depression patients without these symptoms still say they do not feel better.

"There is more to [remission] than the absence of depression. Remission also deals with people getting back to feeling positive," said Dr. Nease, an adjunct associate professor in the Dept. of Family Medicine at the University of Michigan Medical School.

He said, "Our tool can be used as patients approach recovery," giving physicians more insight into a person's progress "than a simple question of, 'Are you feeling better?' "

In the study, researchers administered the PHQ-8 (all questions except one about suicide) and REMIT to 1,003 primary care patients in Indiana and Michigan who were being treated for depression.

Researchers found that about one in three patients who have mild depression did not exhibit the positive symptoms associated with recovery, even though the individual's PHQ score indicated that he or she was in remission.

A score of less than 5 -- after scoring higher on previous tests -- denotes remission of symptoms.

Additionally, about one in three moderately depressed patients was doing better than his or her PHQ score alone would denote.

Researchers have not yet determined the REMIT score that indicates a patient is in remission, according to Dr. Nease. It is not yet available for download online. However, when it is, it will be available for free.