Research ArticleOriginal Research

Potential Antidepressant Overtreatment Associated with Office Use of Brief Depression Symptom Measures

Anthony Jerant, Richard L. Kravitz, Erik Fernandez y Garcia, Mitchell D. Feldman, Camille Cipri, Denyse Nishio, Anca Knoepfler, M. Kaleo Wooddell, Victor Baquero and Peter Franks
The Journal of the American Board of Family Medicine September 2014, 27 (5) 611-620; DOI: https://doi.org/10.3122/jabfm.2014.05.140038

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Flow of subjects through the study. *These subjects were excluded by a computerized random sampling program, based on low scores on the telephone-based 8-item Patient Health Questionnaire (PHQ-8) (used in lieu of the 9-item Patient Health Questionnaire [PHQ-9] for initial telephone eligibility screening), because the aim of the parent trial was to oversample patients with higher levels of depression symptoms. The PHQ-9 was administered to all participants in the prestudy visit questionnaire (but was not disclosed to study providers). RCT, randomized controlled trial.

Tables

  • Table 1. Characteristics of the Study Sample by Depression Screener Status and Overall
    CharacteristicsPractice or Provider Use of a Brief Depression Symptom Measure at the Study Visit*Total
    Did Not UseUsed
    Total545 (91.6)50 (8.4)595 (100.0)
    Categorical variables
        Patient sex
            Female316 (58.0)11 (22.0)327 (55.0)
            Male229 (42.0)39 (78.0)268 (45.0)
        Race/ethnicity
            Non-Hispanic white328 (60.2)30 (60.0)358 (60.2)
            Non-Hispanic black88 (16.1)5 (10.0)93 (15.6)
            Hispanic (any race)65 (11.9)9 (18.0)74 (12.4)
            Non-Hispanic, other race64 (11.7)6 (12.0)70 (11.8)
        Education
            College graduate291 (53.8)24 (48.0)315 (53.3)
            Some college175 (32.3)13 (26.0)188 (31.8)
            High school graduate65 (12.0)12 (24.0)77 (13.0)
            <High school10 (1.8)1 (2.0)11 (1.9)
        Practice setting
            Multispecialty group269 (49.4)5 (10.0)274 (46.1)
            Academic179 (32.8)12 (24.0)191 (32.1)
            Veterans Administration60 (11.0)25 (50.0)85 (14.3)
            Health maintenance organization37 (6.8)8 (16.0)45 (7.6)
    Trial intervention group
            Intervention 1192 (35.2)19 (38.0)211 (35.5)
            Intervention 2176 (32.3)13 (26.0)189 (31.8)
            Attention control video177 (32.5)18 (36.0)195 (32.8)
    Continuous variables
        Age, mean (SD)52.4 (11.7)53.5 (12.5)52.5 (11.8)
        Health status
            Mental (MCS-12), mean (SD)51.2 (9.2)48.5 (8.0)51.0 (9.2)
            Physical (PCS-12), mean (SD)43.7 (12.8)44.1 (10.5)43.7 (12.6)

    • Data are n (%) unless otherwise indicated.

    • ↵* Based on a review of the study visit note in the medical record.

    • MCS-12, 12-item Short Form Mental Component Summary score; PCS-12, 12-item Short Form Physical Component Summary score; SD, standard deviation.

  • Table 2. Number and Percentage of Study Visits with Depression Diagnosis and with Antidepressant Recommendation and/or Prescription at Various Study 9-Item Patient Health Questionnaire (PHQ-9) Score Thresholds
    PHQ-9 ScoreAll VisitsVisits with Practice or Provider Use of a Brief Depression Symptom Measure
    Visits (n)Depression Diagnosis*Antidepressant Recommendation and/or Prescription*Visits (n)Depression Diagnosis*Antidepressant Recommendation and/or Prescription*
    <1059567 (11.3)42 (7.1)5010 (20.0)12 (24.0)
    <953856 (10.4)32 (6.0)4310 (23.3)10 (23.3)
    <848645 (9.3)31 (6.4)368 (22.2)9 (25.0)
    <742135 (8.3)21 (5.0)286 (21.4)8 (28.6)
    <636929 (7.9)19 (5.2)235 (21.7)7 (30.4)
    <530420 (6.6)11 (3.6)184 (22.2)4 (22.0)

    • Data are n (%) unless otherwise indicated. The PHQ-9 was administered to all participants in the prestudy visit questionnaire (but was not disclosed to study providers).

    • ↵* Based on a review of the study visit note in the medical record.

  • Table 3. Adjusted Odds of Depression Diagnosis, Antidepressant Recommendation, and/or Prescription and Antidepressant Prescription Alone Associated with Use of Brief Depression Symptom Measure
    PHQ-9 ScoreDepression Diagnosis*Antidepressant Recommendation and/or Prescription*Antidepressant Prescription Alone*
    AOR (95% CI)PAOR (95% CI)PAOR (95% CI)P
    <103.2 (1.1–9.2).023.8 (1.0–13.9).044.1 (1.1–16.2).04
    <94.4 (1.4–13.1).0084.8 (1.1–20.2).046.0 (1.2–30.9).03
    <84.7 (1.5–15.1).014.4 (1.0–19.7).056.3 (1.2–33.3).03
    <76.1 (1.6–22.7).0077.6 (1.8–32.2).0067.0 (1.3–37.6).02
    <65.5 (1.4–22.3).026.9 (1.4–35.1).027.1 (1.3–38.6).02
    <511.1 (2.6–47.6).001155.2 (0.7–32,540.6).061.7 (0.1–24.8).69

    • The PHQ-9 was administered to all participants in the prestudy visit questionnaire (but was not disclosed to study providers).

    • ↵* Based on a review of the study visit note in the medical record. Values are adjusted for nesting of patients within providers; trial intervention group; trial stratification variables (practice setting [academic versus nonacademic], patient sex, and patient race/ethnicity category [non-Hispanic white or all others]); and trial sample weighting (ie, oversampling of people with higher levels of depressive symptoms [PHQ-9 score >5]).

    • AOR, adjusted odds ratio; CI, confidence interval; PHQ-9, 9-item patient health questionnaire.

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