May 12, 2020 – Annals of Internal Medicine
The development of standard diagnostic criteria for American Psychiatric Association, working with the New York Academy of Medicine, developed mental health classiﬁcations that were used in the American Medical Association’s Standard Classiﬁed Nomenclature of Dis-ease. In 1949, the World Health Organization published the sixth edition of their International Classiﬁcation of Diseases, which included for the ﬁrst time a section on mental disorders. This was followed in 1952 by the ﬁrst edition of the Diagnostic and Statistical Manual of Mental Disorders, which has subsequently under-gone regular revisions, most recently in 2013 with its ﬁfth edition (1). This codiﬁcation helped clarify both research and clinical deﬁnitions and has led to signiﬁcant progress in mental health care assessment and treatment. Regular revision has also allowed changes that reﬂect better understanding of mental disorders.
Among the various mental health conditions, depression is the most common in both primary care and specialty settings (2). Over the years, numerous instruments have been used to diagnose and monitor depression, many requiring special training or signiﬁcant time to complete. An important advance in caring for primary care patients with depression was the development of the Patient Health Questionnaire–9 (PHQ-9) (3), a simple instrument for diagnosing depression, assessing its severity, and monitoring response to treatment. The PHQ-9 can be self-administered by patients and takes only a few minutes to complete. It has been incorporated into routine screening and management processes in many large health care systems, including Kaiser Permanente and the Veterans Health Administration.
In their article, Gliklich and colleagues (4) report on a national initiative to develop “harmonized” outcome measures for depression. This is an important next step because, as the authors point out, “a lack of uniformity remains in measurements and monitoring for depression both in clinical practice and research settings” (4). Many registries and systems across the country track patients with depression using various instruments and outcome deﬁnitions (5). This variability impairs comparisons across systems and practices. The depressive out-comes Gliklich and colleagues selected include survival, clinical response, events of interest, quality of life, resource use, and work productivity. In addition, the authors provide speciﬁc measures within each of these domains.