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Brief symptom scale identifies 6-month risk for depressive relapse in fully remitted depression

Recent findings suggest a brief symptom scale can identify risk for depressive relapse within the next 6 months among individuals with fully remitted depression.

“Current guidance recommends visits every 1 to 6 months based on clinical judgment. However, if we could develop a clinical tool for estimating the likelihood of relapse for a given patient after complete remission, we would be able to tailor the follow-up visit schedule individually,” Lewis L. Judd, MD, of University of California, San Diego, and colleagues wrote. “Patients more likely to relapse could be followed up more often, in person or by telephone, whereas those at lower risk of relapse could be seen less frequently. Care would be more efficient, and, if needed, interventions could be delivered in a timelier fashion to patients with impending or actual relapses.”

To develop a brief clinical tool estimating risk for depressive relapse following remission, researchers evaluated 188 individuals with major depressive disorder from the NIMH Collaborative Depression Study who had at least one Symptom Checklist-90 (SCL-90) assessment after 8 weeks of full depressive remission.

Overall, 14.2% of SCL-90 assessments were followed by depressive relapse within 6 months.

Seventeen SCL-90 items significantly identified relapse from non-relapse. These included feeling blocked in getting things done, feeling pushed to get things done, feeling tense or keyed up, having ideas/beliefs others do not share, feeling inferior to others, feelings of worthlessness, feeling low in energy or slowed down, feeling blue, feeling very self-conscious with others, headaches, feeling lonely, crying easily, feeling no interest in things, feelings being easily hurt, worrying too much, trouble concentrating and feeling everything is an effort.

Twelve of these items contributed to prediction of 6-month relapse, according to forward- and backward-stepping mixed-model logistic regression analysis.

Experiencing one or more of these symptoms predicted a period of relapse with a sensitivity of 80.8% and specificity of 51.2%, a positive predictive value of 21.5% and negative predictive value of 94.2%.

Relapse occurred 5.8% of the time when none of the 12 symptoms were present; 16.4% when one to five symptoms were present; 34.1% when six to nine symptoms were present; and 72.7% when 10 or more symptoms were present.

“About one in seven fully remitted, formerly depressed patients experienced clinically meaningful depressive relapses over the next 6 months. These relapses were associated with a far worse course of depression over the ensuing 5 years,” the researchers wrote. “As a proof of concept, we have demonstrated that a brief 12-item symptom-based tool can provide an estimate of the risk of relapse for individual patients. Such simple, clinically based indicators can provide a platform onto which laboratory-based measures could be added to further personalize patient care.” – by Amanda Oldt

Disclosure: Judd reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.