Indicators of patients with major depressive disorder in need of highly specialized care: A systematic review

Frédérique C W van Krugten, Meriam Kaddouri, Maartje Goorden, Anton J L M van Balkom, Claudi L H Bockting, Frenk P M L Peeters, Leona Hakkaart-van Roijen, Decision Tool Unipolar Depression (DTUD) Consortium, Frédérique C W van Krugten, Meriam Kaddouri, Maartje Goorden, Anton J L M van Balkom, Claudi L H Bockting, Frenk P M L Peeters, Leona Hakkaart-van Roijen, Decision Tool Unipolar Depression (DTUD) Consortium

Abstract

Objectives: Early identification of patients with major depressive disorder (MDD) that cannot be managed by secondary mental health services and who require highly specialized mental healthcare could enhance need-based patient stratification. This, in turn, may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response. The development of a valid tool to identify patients with MDD in need of highly specialized care is hampered by the lack of a comprehensive understanding of indicators that distinguish patients with and without a need for highly specialized MDD care. The aim of this study, therefore, was to systematically review studies on indicators of patients with MDD likely in need of highly specialized care.

Methods: A structured literature search was performed on the PubMed and PsycINFO databases following PRISMA guidelines. Two reviewers independently assessed study eligibility and determined the quality of the identified studies. Three reviewers independently executed data extraction by using a pre-piloted, standardized extraction form. The resulting indicators were grouped by topical similarity, creating a concise summary of the findings.

Results: The systematic search of all databases yielded a total of 7,360 references, of which sixteen were eligible for inclusion. The sixteen papers yielded a total of 48 unique indicators. Overall, a more pronounced depression severity, a younger age of onset, a history of prior poor treatment response, psychiatric comorbidity, somatic comorbidity, childhood trauma, psychosocial impairment, older age, and a socioeconomically disadvantaged status were found to be associated with proxies of need for highly specialized MDD care.

Conclusions: Several indicators are associated with the need for highly specialized MDD care. These indicators provide easily measurable factors that may serve as a starting point for the development of a valid tool to identify patients with MDD in need of highly specialized care.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart of study selection…
Fig 1. Flow chart of study selection process.
RCT, Randomized controlled trial; MDD, major depressive disorder; DSM, Diagnostic and Statistical Manual of Mental Disorders; ICD, International Classification of Diseases.

References

    1. Kessler RC, Angermeyer M, Anthony JC, DE Graaf R, Demyttenaere K, Gasquet I, et al. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry. 2007;6: 168–176.
    1. Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc. 2009;18: 23–33.
    1. Mathers CD, Loncar D. Projections of Global Mortality and Burden of Disease from 2002 to 2030. PLoS Med. 2006;3.
    1. Boenisch S, Kocalevent RD, Matschinger H, Mergl R, Wimmer-Brunauer C, Tauscher M, et al. Who receives depression-specific treatment? A secondary data-based analysis of outpatient care received by over 780,000 statutory health-insured individuals diagnosed with depression. Soc Psychiatry Psychiatr Epidemiol. 2012;47: 475–486. 10.1007/s00127-011-0355-y
    1. Oquendo MA, Kamali M, Ellis SP, Grunebaum MF, Malone KM, Brodsky BS, et al. Adequacy of antidepressant treatment after discharge and the occurrence of suicidal acts in major depression: a prospective study. Am J Psychiatry. 2002;159: 1746–1751. 10.1176/appi.ajp.159.10.1746
    1. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. 2007;370: 841–850. 10.1016/S0140-6736(07)61414-7
    1. Kocsis JH, Gelenberg AJ, Rothbaum B, Klein DN, Trivedi MH, Manber R, et al. Chronic forms of major depression are still undertreated in the 21st century: Systematic assessment of 801 patients presenting for treatment. J Affect Disord. 2008;110: 55–61. 10.1016/j.jad.2008.01.002
    1. Meyers BS, Sirey JA, Bruce M, Hamilton M, Raue P, Friedman SJ, et al. Predictors of early recovery from major depression among persons admitted to community-based clinics: an observational study. Arch Gen Psychiatry. 2002;59: 729–735.
    1. Isacsson G, Boethius G, Bergman U. Low level of antidepressant prescription for people who later commit suicide: 15 years of experience from a population-based drug database in Sweden. Acta Psychiatr Scand. 1992;85: 444–448.
    1. Isometsa ET, Henriksson MM, Aro HM, Heikkinen ME, Kuoppasalmi KI, Lonnqvist JK. Suicide in major depression. Am J Psychiatry. 1994;151: 530–536. 10.1176/ajp.151.4.530
    1. Suominen KH, Isometsa ET, Henriksson MM, Ostamo AI, Lonnqvist JK. Inadequate treatment for major depression both before and after attempted suicide. Am J Psychiatry. 1998;155: 1778–1780. 10.1176/ajp.155.12.1778
    1. Wang PS, Simon G, Kessler RC. The economic burden of depression and the cost-effectiveness of treatment. Int J Methods Psychiatr Res. 2003;12: 22–33.
    1. Hirschfeld RM, Keller MB, Panico S, Arons BS, Barlow D, Davidoff F, et al. The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. JAMA. 1997;277: 333–340.
    1. Meldon SW, Mion LC, Palmer RM, Drew BL, Connor JT, Lewicki LJ, et al. A Brief Risk-stratification Tool to Predict Repeat Emergency Department Visits and Hospitalizationsin Older Patients Discharged from the Emergency Department. Acad Emerg Med. 2003;10: 224–232.
    1. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137: 263–272. 10.1378/chest.09-1584
    1. Cooperberg MR, Broering JM, Carroll PR. Risk assessment for prostate cancer metastasis and mortality at the time of diagnosis. J Natl Cancer Inst. 2009;101: 878–887. 10.1093/jnci/djp122
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339: b2700 10.1136/bmj.b2700
    1. Garg S, Sarno G, Garcia-Garcia HM, Girasis C, Wykrzykowska J, Dawkins KD, et al. A new tool for the risk stratification of patients with complex coronary artery disease: the Clinical SYNTAX Score. Circ Cardiovasc Interv. 2010;3: 317–326. 10.1161/CIRCINTERVENTIONS.109.914051
    1. Holzel L, Harter M, Reese C, Kriston L. Risk factors for chronic depression—a systematic review. J Affect Disord. 2011;129: 1–13. 10.1016/j.jad.2010.03.025
    1. Burcusa SL, Iacono WG. Risk for recurrence in depression. Clin Psychol Rev. 2007;27: 959–985. 10.1016/j.cpr.2007.02.005
    1. Riso LP, Miyatake RK, Thase ME. The search for determinants of chronic depression: a review of six factors. J Affect Disord. 2002;70: 103–115.
    1. Bennabi D, Aouizerate B, El-Hage W, Doumy O, Moliere F, Courtet P, et al. Risk factors for treatment resistance in unipolar depression: A systematic review. J Affect Disord. 2015;171: 137–141. 10.1016/j.jad.2014.09.020
    1. Lee AS. Better outcomes for depressive disorders? Psychol Med. 2003;33: 769–774.
    1. World Health Organization. Improving health systems and services for mental health. 2009. Available: .
    1. Wasylenki D, Goering P, Cochrane J, Durbin J, Rogers J, Prendergast P. Tertiary mental health services: I. Key concepts. Can J Psychiatry. 2000;45: 179–184.
    1. Cochrane J, Goering P, Durbin J, Butterill D, Dumas J, Wasylenki D. Tertiary mental health services: II. Subpopulations and best practices for service delivery. Can J Psychiatry. 2000;45: 185–190.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-III). 3rd Edition Arlington, VA: American Psychiatric Publishing; 1980.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM III-R). 3rd Edition Arlington, VA: American Psychiatric Publishing; 1987.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th Edition Arlington, VA: American Psychiatric Publishing; 1994.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: Text revision (DSM-IV-TR). 4th Edition Arlington, VA: American Psychiatric Publishing; 2000.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th Edition Arlington, VA: American Psychiatric Publishing; 2013.
    1. World Health Organization. International Classification of Diseases, Ninth Revision: Geneva: World Health Organization; 1977.
    1. World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines: Geneva: World Health Organization; 1992.
    1. Spitzer RL, Endicott J, Robins E. Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry. 1978;35: 773–782.
    1. VonVille HM. Organizing Search Data for Methods Reporting. 2014. Available: .
    1. National Heart, Blood and Lung Institute. Quality assessment tool for observational cohort and cross-sectional studies. 2014. Available: .
    1. National Heart, Blood and Lung Institute. Quality Assessment Tool for Case-Control Studies. 2014. Available: .
    1. Kaplan MJ, Klinetob NA. Childhood emotional trauma and chronic posttraumatic stress disorder in adult outpatients with treatment-resistant depression. J Nerv Ment Dis. 2000;188: 596–601.
    1. Souery D, Oswald P, Massat I, Bailer U, Bollen J, Demyttenaere K, et al. Clinical factors associated with treatment resistance in major depressive disorder: results from a European multicenter study. J Clin Psychiatry. 2007;68: 1062–1070.
    1. Amital D, Fostick L, Silberman A, Beckman M, Spivak B. Serious life events among resistant and non-resistant MDD patients. J Affect Disord. 2008;110: 260–264. 10.1016/j.jad.2008.01.006
    1. Dudek D, Rybakowski JK, Siwek M, Pawlowski T, Lojko D, Roczen R, et al. Risk factors of treatment resistance in major depression: Association with bipolarity. J Affect Disord. 2010;126: 268–271. 10.1016/j.jad.2010.03.001
    1. Takahashi M, Shirayama Y, Muneoka K, Suzuki M, Sato K, Hashimoto K. Low openness on the Revised NEO Personality Inventory as a risk factor for treatment-resistant depression. PLoS One. 2013;8: e71964–7. 10.1371/journal.pone.0071964
    1. Takahashi M, Shirayama Y, Muneoka K, Suzuki M, Sato K, Hashimoto K. Personality traits as risk factors for treatment-resistant depression. PLoS One. 2013;8: e63756 10.1371/journal.pone.0063756
    1. Riso LP, du Toit PL, Blandino JA, Penna S, Dacey S, Duin JS, et al. Cognitive aspects of chronic depression. J Abnorm Psychol. 2003;112: 72–80.
    1. Gilmer WS, Trivedi MH, Rush AJ, Wisniewski SR, Luther J, Howland RH, et al. Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta Psychiatr Scand. 2005;112: 425–433. 10.1111/j.1600-0447.2005.00633.x
    1. Wiersma JE, Hovens JG, van Oppen P, Giltay EJ, van Schaik DJ, Beekman AT, et al. The importance of childhood trauma and childhood life events for chronicity of depression in adults. J Clin Psychiatry. 2009;70: 983–989.
    1. Wiersma JE, van Oppen P, van Schaik DJ, van der Does AJ, Beekman AT, Penninx BW. Psychological characteristics of chronic depression: a longitudinal cohort study. J Clin Psychiatry. 2011;72: 288–294. 10.4088/JCP.09m05735blu
    1. Melartin TK, Rytsala HJ, Leskela US, Lestela-Mielonen PS, Sokero TP, Isometsa ET. Severity and comorbidity predict episode duration and recurrence of DSM-IV major depressive disorder. J Clin Psychiatry. 2004;65: 810–819.
    1. Solomon DA, Leon AC, Endicott J, Mueller TI, Coryell W, Shea MT, et al. Psychosocial Impairment and Recurrence of Major Depression. Compr Psychiatry. 2004;45: 423–430. 10.1016/j.comppsych.2004.07.002
    1. Bos EH, Bouhuys AL, Geerts E, Van Os TW, Van der Spoel ID, Brouwer WH, et al. Cognitive, physiological, and personality correlates of recurrence of depression. J Affect Disord. 2005;87: 221–229. 10.1016/j.jad.2005.04.001
    1. Hollon SD, Shelton RC, Wisniewski S, Warden D, Biggs MM, Friedman ES, et al. Presenting characteristics of depressed outpatients as a function of recurrence: preliminary findings from the STAR*D clinical trial. J Psychiatr Res. 2006;40: 59–69. 10.1016/j.jpsychires.2005.07.008
    1. Gerrits MM, van Oppen P, Leone SS, van Marwijk HW, van der Horst HE, Penninx BW. Pain, not chronic disease, is associated with the recurrence of depressive and anxiety disorders. BMC Psychiatry. 2014;14: 187–244. 10.1186/1471-244X-14-187
    1. Lamers F, Beekman AT, de Jonge P, Smit JH, Nolen WA, Penninx BW. One-year severity of depressive symptoms: results from the NESDA study. Psychiatry Res. 2011;190: 226–231. 10.1016/j.psychres.2011.07.005
    1. Butcher JN, Dahlstrom WG, Graham JR, Tellegen A, Kaemmer B. Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press; 1989.
    1. Endicott J, Nee J, Harrison W, Blumenthal R. Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacol Bull. 1993;29: 321–326.
    1. Pollack MM, Alexander SR, Clarke N, Ruttimann UE, Tesselaar HM, Bachulis AC. Improved outcomes from tertiary center pediatric intensive care: a statewide comparison of tertiary and nontertiary care facilities. Crit Care Med. 1991;19: 150–159.
    1. Ryabchenko KA, Pepper CM, Jeglic EL, Griffith JW, Miller AB. Differences in course and comorbidity of recurrent depression in primary care and psychiatric populations. Depress Anxiety. 2004;20: 153–154. 10.1002/da.20034
    1. Hardeveld F, Spijker J, De Graaf R, Nolen W, Beekman A. Prevalence and predictors of recurrence of major depressive disorder in the adult population. Acta Psychiatr Scand. 2010;122: 184–191. 10.1111/j.1600-0447.2009.01519.x
    1. van Weel-Baumgarten EM, Schers H, Van den Bosch W, Van den Hoogen H, Zitman F. Long-term follow-up of depression among patients in the community and in family practice settings: a systematic review. J Fam Pract. 2000;49: 1113–1113.
    1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312: 71–72.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe