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      Defining successful treatment outcome in depression using the PHQ-9: a comparison of methods.

      Journal of Affective Disorders
      Adolescent, Adult, Aged, Case Management, Cooperative Behavior, Depressive Disorder, Major, diagnosis, psychology, therapy, Female, Great Britain, Humans, Interdisciplinary Communication, Interview, Psychological, Male, Middle Aged, Personality Inventory, statistics & numerical data, Primary Health Care, Psychometrics, Reproducibility of Results, Young Adult

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          Abstract

          Although the PHQ-9 is widely used in primary care, little is known about its performance in quantifying improvement. The original validation study of the PHQ-9 defined clinically significant change as a post-treatment score of ≤9 combined with improvement of 50%, but it is unclear how this relates to other theoretically informed methods of defining successful outcome. We compared a range of definitions of clinically significant change (original definition, asymptomatic criterion, reliable and clinically significant change criteria a, b and c) in a clinical trial of a community-level depression intervention. Randomised Control Trial of collaborative care for depression. Levels of agreement were calculated between the standard definition, other definitions, and gold-standard diagnostic interview. The standard definition showed good agreement (kappa>0.60) with the other definitions and had moderate, though acceptable, agreement with the diagnostic interview (kappa=0.58). The standard definition corresponded closely to reliable and clinically significant change criterion c, the recommended method of quantifying improvement when clinical and non-clinical distributions overlap. The absence of follow-up data meant that an asymptomatic criterion rather than remission or recovery criteria were used. The close agreement between the standard definition and reliable and clinically significant change criterion c provides some support for the standard definition of improvement. However, it may be preferable to use a reliable change index rather than 50% improvement. Remission status, based on the asymptomatic range and a lower PHQ-9 score, may provide a useful additional category of clinical change. Copyright © 2010 Elsevier B.V. All rights reserved.

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