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Randomized Controlled Trial
. 2024 Jun 27;74(744):e456-e465.
doi: 10.3399/BJGP.2023.0539. Print 2024 Jul.

Depression follow-up monitoring with the PHQ-9: an open cluster-randomised controlled trial

Tony Kendrick  1 , Christopher Dowrick  2 , Glyn Lewis  3 , Michael Moore  1 , Geraldine M Leydon  1 , Adam Wa Geraghty  1 , Gareth Griffiths  4 , Shihua Zhu  1 , Guiqing Lily Yao  5 , Carl May  6 , Mark Gabbay  2 , Rachel Dewar-Haggart  1 , Samantha Williams  1 , Lien Bui  1 , Natalie Thompson  1 , Lauren Bridewell  1 , Emilia Trapasso  2 , Tasneem Patel  2 , Molly McCarthy  2 , Naila Khan  2 , Helen Page  2 , Emma Corcoran  3 , Jane Sungmin Hahn  3 , Molly Bird  3 , Mekeda X Logan  3 , Brian Chi Fung Ching  3 , Riya Tiwari  1 , Anna Hunt  1 , Beth Stuart  7
Affiliations
Randomized Controlled Trial

Depression follow-up monitoring with the PHQ-9: an open cluster-randomised controlled trial

Tony Kendrick et al. Br J Gen Pract. .

Abstract

Background: Outcome monitoring of depression treatment is recommended but there is a lack of evidence on patient benefit in primary care.

Aim: To test monitoring depression using the Patient Health Questionnaire (PHQ-9) with patient feedback.

Design and setting: An open cluster-randomised controlled trial was undertaken in 141 group practices.

Method: Adults with new depressive episodes were recruited through record searches and opportunistically. The exclusion criteria were as follows: dementia; psychosis; substance misuse; and suicide risk. The PHQ-9 was administered soon after diagnosis, and 10-35 days later. The primary outcome was the Beck Depression Inventory (BDI-II) score at 12 weeks. The secondary outcomes were as follows: BDI-II at 26 weeks; Work and Social Adjustment Scale (WSAS) and EuroQol EQ-5D-5L quality of life at 12 and 26 weeks; antidepressant treatment; mental health and social service contacts; adverse events, and Medical Interview Satisfaction Scale (MISS) over 26 weeks.

Results: In total, 302 patients were recruited to the intervention arm and 227 to the controls. At 12 weeks, 254 (84.1%) and 199 (87.7%) were followed-up, respectively. Only 40.9% of patients in the intervention had a GP follow-up PHQ-9 recorded. There was no significant difference in BDI-II score at 12 weeks (mean difference -0.46; 95% confidence interval [CI] = -2.16 to 1.26; adjusted for baseline depression, baseline anxiety, sociodemographic factors, and clustering by practice). EQ-5D-5L quality-of-life scores were higher in the intervention arm at 26 weeks (adjusted mean difference 0.053; 95% CI = 0.013 to 0.093. A clinically significant difference in depression at 26 weeks could not be ruled out. No significant differences were found in social functioning, adverse events, or satisfaction. In a per-protocol analysis, antidepressant use and mental health contacts were significantly greater in patients in the intervention arm with a recorded follow-up PHQ-9 (P = 0.025 and P = 0.010, respectively).

Conclusion: No evidence was found of improved depression outcome at 12 weeks from monitoring. The findings of possible benefits over 26 weeks warrant replication, investigating possible mechanisms, preferably with automated delivery of monitoring and more instructive feedback.

Keywords: depression; mental health; mood disorders; patient reported outcome measures; primary health care.

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Conflict of interest statement

All authors completed a disclosure form at: http://www.icmje.org/coi_disclosure.pdf. For further details, see Supplementary Information S5.

Figures

Figure 1.
Figure 1.
CONSORT diagram. NP = nurse practitioner. NB: 58 intervention arm patients who missed follow-up at 12 weeks returned to follow-up at 26 weeks.
Figure 2.
Figure 2.
Mean BDI-II depression scores at baseline, 12 weeks, and 26 weeks follow-up.
Figure 3.
Figure 3.
Mean EQ-5D-5L quality-of-life scores at baseline, 12 weeks, and 26 weeks follow-up.
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References

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