New Tool to Assess Remission in Depression

It is estimated that 1 in 10 office visits in primary care are patients presenting with a diagnosis of depression. Researchers from the University of Michigan Department of Family Medicine have developed a new tool that may help clinicians better evaluate the extent to which a patient’s depression has improved. The study is published in the June issue of General Hospital Psychiatry.

The authors decided to develop their own assessment tool primarily because the ‘official Diagnostic and Statistical Manual of Mental Disorders definition of when a patient’s symptoms are in remission doesn’t always match up with what doctors see in a real-world practice, especially for patients with mild to moderate symptoms.’  The Remission Evaluation and Mood Inventory Tool (REMIT) was developed to complement current validated criterion-based measures such as the PHQ-9 or the Quick Inventory of Depressive Symptomatology (QIDS). Validation was matched against these standardized measures in a cross-sectional sample of 1000 adult primary care patients at various stages of treatment for depression. The data showed that by adding in the REMIT questions, about one-third of patients with mild depression were not in remission, as their PHQ score would indicate. Additionally, about one-third of moderately depressed patients were doing better than their PHQ scores alone would denote.

Evidence-based treatment guidelines for the management of depression have been widely disseminated, and current guidelines often incorporate innovations such as the use of measurement-based care and the principle of treatment to remission. However, if the information yielded by monitoring instruments does not capture important, yet missing, elements of depression recovery, clinicians still must make treatment decisions with incomplete information. The researchers point out that “our results suggest that the five questions we have identified in REMIT close a substantial amount of the gap of additional elements or constructs important in assessing patients’ recovery from depression.”

The authors conclude that they have sought to create an instrument with real world clinical value, and “we look forward to future work to verify and refine its value and utility.” “As it stands, REMIT is ready for testing by clinicians and researchers in both clinical practice and trial settings as a companion to the PHQ-9, QIDS or other depression measures. We believe it represents a significant step forward in painting a fuller picture of depression recovery.”

Article: Nease DE Jr, Aikens JE, Klinkman MS, Kroenke K, Sen A. Toward a more comprehensive assessment of depression remission: the Remission Evaluation and Mood Inventory Tool (REMIT). Gen Hosp Psychiatry. 2011 May-Jun;33(3):279-86. Epub 2011 May 6.