New Tool for Early Identification of Patients With Major Depressive Disorder

Physician speaking with a patient
Physician speaking with a patient
Investigators believe that their data show that the Decision Tool Unipolar Depression fills the gap from presentation in a primary care physician's office to high-intensity treatment in patients with major depressive disorder.

The Decision Tool Unipolar Depression (DTUD), which has exhibited solid psychometric properties, is a promising measure for the early identification of patients with major depressive disorder (MDD) who require highly specialized care. Use of the DTUD has the potential to enable the selection and initiation of optimal therapy in patients with MDD, thus helping to improve both the clinical efficacy and the cost-effectiveness of certain treatment strategies. A cross-sectional, multicenter study on the subject was conducted in The Netherlands, with the results published in BMC Psychiatry.

The investigators sought to create a valid, reliable, clinician-administered measure that is both short and easy to score to facilitate the early identification of those patients with MDD in need of highly specialized mental healthcare. The following 3 phases were involved in the development of the DTUD: use of a systemic literature search to identify those indicators of patients with MDD who require highly specialized care, development of a conceptual framework to guide item generation, and creation of the tool, along with assessment of its face validity and feasibility.

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A total of 243 patients with MDD were evaluated via use of the DTUD. Feasibility of the tool was operationalized as the time needed to complete the DTUD and the content clarity of the tool. Completion time was deemed to be acceptable if the mean time required to finish the DTUD was <10 minutes. The clarity of the total DTUD was scored with a “Yes” or “No” response, which was considered acceptable if ≥90% of the informants rated the content of the DTUD as being clear.

Results of the study showed that the mean administration time was 4.49±2.71 minutes. In 94.7% of the evaluations, the content of the total DTUD was considered to be clear. Interrater reliability values, which were measured using Krippendorf’s alpha, ranged from 0.69 to 0.91. Higher DTUD scores were associated with higher scores on the Maudsley Staging Method, which is a 5-item, clinician-administered instrument intended to quantify future treatment-resistant depression. Moreover, higher scores on the DTUD were also linked to higher scores on the Dutch Measure for quantification of Treatment Resistance in Depression, which is an 11-item, clinician-administered instrument that is an extension of the Maudsley Staging Method.

The investigators concluded that the findings from this study lend support for the psychometric properties of the DTUD and the utility of this tool for assessing the selection and initiation of the most appropriate treatment for patients with MDD who require a higher level of mental healthcare.

van Krugten FCW, Goorden M, van Balkom AJLM, et al; Decision Tool Unipolar Depression Consortium. The decision tool unipolar depression (DTUD): a new measure to facilitate the early identification of patients with major depressive disorder in need of highly specialized care.BMC Psychiatry. 2019;19(1):179.