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Brief Reports   |    
Depression Monitoring and Patient Behavior in the Clinical Outcomes in MEasurement-Based Treatment (COMET) Trial
Trina E. Chang, M.D., M.P.H.; Yonghua Jing, Ph.D.; Albert S. Yeung, M.D., Sc.D.; Susan K. Brenneman, Ph.D.; Iftekhar D. Kalsekar, Ph.D.; Tony Hebden, Ph.D.; Robert D. McQuade, Ph.D.; Lee Baer, Ph.D.; Jonathan L. Kurlander, M.S.; Angela K. Watkins, M.A.; Jean A. Siebenaler, M.D.; Maurizio Fava, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300326
View Author and Article Information

Dr. Chang, Dr. Yeung, Dr. Baer, and Dr. Fava are with the Clinical Trials Network and Institute and the Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston (e-mail: techang@partners.org). Dr. Jing and Dr. Hebden, affiliated with Bristol-Myers Squibb at the time of this study, are with AbbVie, North Chicago. Dr. Brenneman, Mr. Kurlander, Ms. Watkins, and Dr. Siebenaler are with Life Sciences Research, Optum, Eden Prairie, Minnesota. Dr. Kalsekar, also with Bristol-Myers Squibb at the time of this study, is with AstraZeneca Pharmaceuticals, Fort Washington, Pennsylvania. Dr. McQuade is with Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, New Jersey.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  In this secondary analysis of results of the Clinical Outcomes in MEasurement-Based Treatment (COMET) trial, patient behaviors that might account for the differences observed in clinical outcomes were examined.

Methods  Patients (N=914) diagnosed as having major depressive disorder participated in telephone interviews either monthly for six months (intervention) or at three and six months (usual care) asking about antidepressant medication–taking, use of psychotherapy or counseling, and participation in depression support groups. Physicians (N=83) in the intervention arm received monthly feedback regarding their patients’ depression severity.

Results  A total of 664 (73%) patients completed the month 6 interview. The adjusted odds of current antidepressant use at six months were 85% greater (p=.01) for patients in the intervention (N=380) versus usual care (N=284) arms, according to multivariate regression analyses.

Conclusions  More frequent measurement of depression symptoms was associated with greater medication persistence, which in turn may have mediated clinical improvements.

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Table 1Multivariate analysis of the effect of usual care and the COMET intervention on medication-taking behavior and other depression-treatment variables at 3- and 6-month follow-upsa
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a COMET, Clinical Outcomes in MEasurement-Based Treatment

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b The analysis adjusted for age at enrollment (<65 or ≥65), gender, marital status, insurance status, employment status (full-time or not), race (black or African American or white), ethnicity (Hispanic/Latino or not), presence of anxiety disorder, chronic pain disorder or other comorbidity, and baseline Patient Health Questionnaire–9 depression score category (mild, moderate, or moderately severe compared with severe).

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c Chi square test

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d Participants with missing baseline data for demographic or clinical characteristics or follow-up data were excluded from the multivariate analyses.

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e The multivariate analyses for the six-month follow-up combined results from the 3- and 6-month follow-ups.

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References

Yeung  AS;  Jing  Y;  Brenneman  SK  et al:  Clinical Outcomes in Measurement-Based Treatment (COMET): a trial of depression monitoring and feedback to primary care physicians.  Depression and Anxiety 29:865–873, 2012
[CrossRef] | [PubMed]
 
Chang  TE;  Jing  Y;  Yeung  AS  et al:  Effect of communicating depression severity on physician prescribing patterns: findings from the Clinical Outcomes in MEasurement-based Treatment (COMET) trial.  General Hospital Psychiatry 34:105–112, 2012
[CrossRef] | [PubMed]
 
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Kroenke  K;  Spitzer  RL;  Williams  JB:  The PHQ-9: validity of a brief depression severity measure.  Journal of General Internal Medicine 16:606–613, 2001
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