The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression.

ContextIn 2002, an estimated 877 000 lives were lost worldwide through
suicide. Some developed nations have implemented national suicide prevention
plans. Although these plans generally propose multiple interventions, their
effectiveness is rarely evaluated.ObjectivesTo examine evidence for the effectiveness of specific suicide-preventive
interventions and to make recommendations for future prevention programs and
research.Data Sources and Study SelectionRelevant publications were identified via electronic searches of MEDLINE,
the Cochrane Library, and PsychINFO databases using multiple search terms
related to suicide prevention. Studies, published between 1966 and June 2005,
included those that evaluated preventative interventions in major domains;
education and awareness for the general public and for professionals; screening
tools for at-risk individuals; treatment of psychiatric disorders; restricting
access to lethal means; and responsible media reporting of suicide.Data ExtractionData were extracted on primary outcomes of interest: suicidal behavior
(completion, attempt, ideation), intermediary or secondary outcomes (treatment
seeking, identification of at-risk individuals, antidepressant prescription/use
rates, referrals), or both. Experts from 15 countries reviewed all studies.
Included articles were those that reported on completed and attempted suicide
and suicidal ideation; or, where applicable, intermediate outcomes, including
help-seeking behavior, identification of at-risk individuals, entry into treatment,
and antidepressant prescription rates. We included 3 major types of studies
for which the research question was clearly defined: systematic reviews and
meta-analyses (n = 10); quantitative studies, either randomized
controlled trials (n = 18) or cohort studies (n = 24);
and ecological, or population- based studies (n = 41). Heterogeneity
of study populations and methodology did not permit formal meta-analysis;
thus, a narrative synthesis is presented.Data SynthesisEducation of physicians and restricting access to lethal means were
found to prevent suicide. Other methods including public education, screening
programs, and media education need more testing.ConclusionsPhysician education in depression recognition and treatment and restricting
access to lethal methods reduce suicide rates. Other interventions need more
evidence of efficacy. Ascertaining which components of suicide prevention
programs are effective in reducing rates of suicide and suicide attempt is
essential in order to optimize use of limited resources.

Suicide prevention strategies: a systematic review.

An ultra-brief screening scale for anxiety and depression: the PHQ-4.

ContextFew depressed older adults receive effective treatment in primary care
settings.ObjectiveTo determine the effectiveness of the Improving Mood–Promoting
Access to Collaborative Treatment (IMPACT) collaborative care management program
for late-life depression.DesignRandomized controlled trial with recruitment from July 1999 to August
2001.SettingEighteen primary care clinics from 8 health care organizations in 5
states.ParticipantsA total of 1801 patients aged 60 years or older with major depression
(17%), dysthymic disorder (30%), or both (53%).InterventionPatients were randomly assigned to the IMPACT intervention (n = 906)
or to usual care (n = 895). Intervention patients had access for up to 12
months to a depression care manager who was supervised by a psychiatrist and
a primary care expert and who offered education, care management, and support
of antidepressant management by the patient's primary care physician or a
brief psychotherapy for depresssion, Problem Solving Treatment in Primary
Care.Main Outcome MeasuresAssessments at baseline and at 3, 6, and 12 months for depression, depression
treatments, satisfaction with care, functional impairment, and quality of
life.ResultsAt 12 months, 45% of intervention patients had a 50% or greater reduction
in depressive symptoms from baseline compared with 19% of usual care participants
(odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of
depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001),
more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group
difference, −0.4; 95% CI, −0.46 to −0.33; P<.001), less functional impairment (range, 0-10; between-group
difference, −0.91; 95% CI, −1.19 to −0.64; P<.001), and greater quality of life (range, 0-10; between-group
difference, 0.56; 95% CI, 0.32-0.79; P<.001) than
participants assigned to the usual care group.ConclusionThe IMPACT collaborative care model appears to be feasible and significantly
more effective than usual care for depression in a wide range of primary care
practices.

https://jamanetwork.com/journals/jama/articlepdf/195599/JOC21093.pdf

Collaborative Care Management of Late-Life Depression in the Primary Care Setting: A Randomized Controlled Trial

This report builds on a highly valued predecessor, the 1994 Institute of Medicine (IOM) report entitled Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. That report provided the basis for understanding prevention science, elucidating its then-existing research base, and contemplating where it should go in the future. This report documents that an increasing number of mental, emotional, and behavioral problems in young people are in fact preventable. The proverbial ounce of prevention will indeed be worth a pound of cure: effectively applying the evidence-based prevention interventions at hand could potentially save billions of dollars in associated costs by avoiding or tempering these disorders in many individuals. Furthermore, devoting significantly greater resources to research on even more effective prevention and promotion efforts, and then reliably implementing the findings of such research, could substantially diminish the human and economic toll.

Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities

for suicide in primary care reduces morbidity and mortality. The remainder of the review focused on the questions of reliable screening tests for suicide risk and the effectiveness of interventions to decrease depression, suicidal ideation, and suicide attempts or completion. One screening study provided limited evidence for the accuracy of suicide screening in a primary care setting. Intervention studies provided fair and mixed evidence that treating those at risk for suicide reduces the number of suicide attempts or completions. The evidence suggests mild to moderate improvement for interventions addressing intermediate outcomes such as suicidal ideation, decreased depressive severity, decreased hopelessness, or improved level of function. Conclusion: Because of the complexity of studying the risk for suicide and the paucity of well-designed research studies, only limited evidence guides the primary care clinician’s assessment and management of suicide risk.

Catherine Mills Burchell

Papers

Screening for Depression in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force