Clinical Characteristics Associated With Response and Remission From Depression Using Measurement-Based Care

Measurement-based care (MBC) is a vital tool in outpatient psychiatric care, enhancing treatment outcomes through systematic symptom monitoring. This study aimed to identify factors associated with remission and response in depression treatment using MBC, focusing on longitudinal changes in Patient Health Questionnaire-9 (PHQ-9) scores.

Electronic health records of 4778 patients aged 12+ from an academic outpatient psychiatry clinic were analyzed. Inclusion criteria required a baseline PHQ-9 score > 9 and at least one follow-up PHQ-9 measurement. Factors associated with treatment response and remission, using different definitions, were evaluated using Cox regression models, adjusting for demographic and clinical covariates.

Response and remission rates were 46.3% and 28.2%, respectively. For response, significant associated factors were combined treatment (HR = 1.189, p = 0.014), follow-up PHQ-9 within 4-9 months (HR = 1.303, p < 0.001), and absence of post-traumatic stress disorder (PTSD) (HR = 0.817, p = 0.018). Key factors associated with faster remission (HR > 1) included combined psychiatry and psychotherapy treatment (HR = 1.189, p = 0.014), timely follow-up PHQ-9 administration within 4-9 months (HR = 1.255, p = 0.002), lower baseline PHQ-9 scores (HR = 0.931, p < 0.001), and absence of PTSD (HR = 0.751, p = 0.010). Alternative remission definitions (PHQ-9 < 12 or < 9) yielded similar findings.

Integrated psychiatry-psychotherapy approaches, regular symptom monitoring, and addressing comorbid conditions like PTSD are critical for improving depression outcomes. The findings shed light on how MBC can be used to evaluate treatment effectiveness, inform clinical practice, and guide optimized treatment strategies.

Integrating MBC into a combined psychiatry-psychotherapy framework and systematically addressing comorbidities provides clinicians with powerful strategies to significantly improve depression remission rates.