Major Depressive Disorder | May 15, 2021 | Clinical Corner

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May 15, 2021

 

Major Depressive Disorder

 

Major depressive disorder (MDD) is the second leading cause of disability worldwide, affecting an estimated 120 million people.1 Screening is to be done once per year in the year that the patient is seen for an encounter. HEDIS measures the percentage of members 12 years of age and older who were screened for clinical depression using a standardized tool and, if screened positive, who received follow-up care   A positive screen MUST have a follow up plan documented in the chart on the date of the positive screen.

 

Clinical Signs to Look For:

  • Depressed mood most of the day, nearly every day, as indicated either by subjective report or observation made by others).
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  • Significant weight loss when not dieting or weight gain
  • Insomnia or hypersomnia nearly every day.
  • Psychomotor agitation or retardation nearly every day
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • Diminished ability to think or concentrate, or indecisiveness, nearly every
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide.

 

Follow-Up Care – Documented follow-up for a positive depression screening must include the following:

  • Additional evaluation or assessment for depression within 30-days of initial positive screen.2
  • A repeat PHQ-9 score documented in their record, performed within 4 months of the initial positive screen.
  • A follow-up PHQ-9 score documented within 4–8 months after the initial elevated PHQ-9 score to document response to treatment or remission4 and again at 12 months.

 

| DEPRESSION SCREENING MEASURE | DEPRESSION REMISSION MEASURE |

           

References:

  1. Murray, C.J.L., T. Vos, R. Lozano, M. Naghavi, A.D. Flaxman, C. Michaud, M. Ezzati, et al. 2013. “Disability-Adjusted Life Years (DALYs) for 291 Diseases and Injuries in 21 regions, 1990–2010: a Systematic Analysis for the Global Burden of Disease Study 2010.” The Lancet 380(9859):2197–23.
  2. https://www.ncqa.org/hedis/measures/depression-screening-and-follow-up-for-adolescents-and-adults/
  3. https://www.ncqa.org/hedis/measures/utilization-of-the-phq-9-to-monitor-depression-symptoms-for-adolescents-and-adults/
  4.  https://www.ncqa.org/hedis/measures/depression-remission-or-response-for-adolescents-and-adults/

 

 

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