Enhancing electronic health record measurement of depression severity and suicide ideation: A distributed ambulatory research in therapeutics network (DARTNet) study

Background: depression is a leading cause of morbidity worldwide. the majority of treatment for depression occurs in primary care,but effective care remains elusive. clinical decision making and comparative studies of real-world antidepressant effectiveness are limited by the absence of clinical measures of severity of illness and suicidality. methods: the distributed ambulatory research in therapeutics network (dartnet) was engaged to systematically collect data using the 9-item patient health questionnaire (phq-9) at the point of care. we used electronic health records (ehrs) and the phq-9 to capture,describe,and compare data on both baseline severity of illness and suicidality and response and suicidality after diagnosis for depressed patients in participating dartnet practices. results: ehr data were obtained for 81,028 episodes of depression (61,464 patients) from 14 clinical organizations. over 9 months,data for 4900 phq-9s were collected from 2969 patients in dartnet practices (this included 1892 phq-9s for 1019 adults and adolescents who had at least one depression diagnosis). only 8.3% of episodes identified in our depression cohort had severity of illness information available in the ehr. for these episodes,considerable variation existed in both severity of illness (32.05% with no depression,26.89% with minimal,19.54% with mild,12.04% with moderate,and 9.47% with severe depression) and suicidality (69.43% with a score of 0,22.58% with a score of 1,4.97% with a score of 2,and 3.02% with a score of 3 on item 9 of the phq-9). patients with an ehr diagnosis of depression and a phq-9 (n = 1019) had similar severity but slightly higher suicidality levels compared with all patients for which phq-9 data were available. the phq-9 showed higher sensitivity for identifying depression response and emergent (after diagnosis) severity and suicidality; 25% to 30% of subjects had some degree of suicidal thought at some point in time according to the phq-9. conclusions: this study demonstrated the value of adding phq-9 data and prescription fulfillment data to ehrs to improve diagnosis and management of depression in primary care and to enable more robust comparative effectiveness research on antidepressants.