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J Affect Disord. 2019 Mar 15;247:81-87. doi: 10.1016/j.jad.2018.12.035. Epub 2018 Dec 18.

Prediction of prolonged treatment course for depressive and anxiety disorders in an outpatient setting: The Leiden routine outcome monitoring study.

Author information

1
Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: s.boer@lumc.nl.
2
Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
3
Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Statistics and Bio-informatics, Leiden University Medical Centre, Leiden, The Netherlands.
4
Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands.

Abstract

OBJECTIVE:

The aim of this study was to improve clinical identification of patients with a prolonged treatment course for depressive and anxiety disorders early in treatment.

METHOD:

We conducted a cohort study in 1.225 adult patients with a depressive or anxiety disorders in psychiatric specialty care setting between 2007 and 2011, with at least two Brief Symptom Inventory (BSI) assessments within 6 months. With logistic regression, we modelled baseline age, gender, ethnicity, education, marital status, housing situation, employment status, psychiatric comorbidity and both baseline and 1st follow-up BSI scores to predict prolonged treatment course (>2 years). Based on the regression coefficients, we present an easy to use risk prediction score.

RESULTS:

BSI at 1st follow-up proved to be a strong predictor for both depressive and anxiety disorders (OR = 2.17 (CI95% 1.73-2.74); OR = 2.52 (CI95% 1.86-3.23)). The final risk prediction score included BSI 1st follow-up and comorbid axis II disorder for depressive disorder, for anxiety disorders BSI 1st follow-up and age were included. For depressive disorders, for 28% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was60% (sensitivity 0.38, specificity 0.81). For anxiety disorders, for 35% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was 52% (sensitivity 0.55, specificity 0.75).

CONCLUSIONS:

A high level of symptoms at 2-6 months of follow-up is a strong predictor for prolonged treatment course. This facilitates early identification of patients at risk of a prolonged course of treatment; in a relatively easy way by a self-assessed symptom severity.

PMID:
30658244
DOI:
10.1016/j.jad.2018.12.035
[Indexed for MEDLINE]

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