Evidence synthesis for determining the responsiveness of depression questionnaires and optimal treatment duration for antidepressant medications [electronic resource] /
investigators, John W. Williams Jr. ... [et al.].
[Washington, D.C.] : Department of Veterans Affairs, Health Services Research & Development Service, [2009]
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[Washington, D.C.] : Department of Veterans Affairs, Health Services Research & Development Service, [2009]
Licensed for access by U. of T. users.
general note
"October 2009."
"Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Durham Veterans Affairs Medical Center/Duke Evidence-based Practice Center, Durham, NC."
Title from PDF cover.
In 2000, the U.S. economic burden of depressive disorders was estimated to be 83.1 billion dollars. This included 31% direct medical costs, 7% suicide-related mortality costs, and 62% workplace costs. A variety of strategies have been tested to improve patient outcomes. Among these, integrated care models have emerged as both effective and cost effective. A recent systematic review identifies symptom monitoring as a key element of these integrated care models. However, the review did not identify the standardized depression scales that are responsive to clinically important change. A separate but important issue raised by Veterans Administration (VA) Stakeholders is how long to continue antidepressant medication for patients who respond to acute phase treatment. Clinical guidelines recommend continuation treatment for 4-6 months for uncomplicated major depression and some national performance measures are linked to these guidelines. However, clinical guidelines for longer-term maintenance phase treatment are more variable and performance indicators (e.g., Healthcare Effectiveness Data and Information Set, HEDIS) do not address maintenance phase treatment. A better understanding of the evidence for long-term treatment efficacy with antidepressants would inform guidelines and performance measurement. The Key Questions (KQ) were: KQ1: In patients with major depressive disorder treated in primary care settings, what assessment tools are responsive to change? This review should specifically address instruments that are feasible for the primary care setting. KQ2: In primary care patients with major depressive disorder who remit with antidepressant medication, what is the minimum treatment duration to decrease the risk of relapse or recurrence? This review will focus on patients without comorbid substance abuse, PTSD, psychosis or other conditions where guidelines would recommend specialty based care.
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Mode of access: World Wide Web.
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