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Depression Remission or Response for Adolescents and Adults (DRR–E)*

This measure assesses the percentage of members 12 years of age and older with a diagnosis of depression and an elevated PHQ-9 score, who had evidence of response or remission within 120−240 days (4–8 months) of the elevated score:

  • Follow-Up PHQ-9. The percentage of members who have a follow-up PHQ-9 score documented within 120−240 days (4–8) months after the initial elevated PHQ-9 score.
  • Depression Remission. The percentage of members who achieved remission within 120−240 days (4–8) months after the initial elevated PHQ-9 score.
  • Depression Response. The percentage of members who showed response within 120−240 days (4–8) months after the initial elevated PHQ-9 score.

Why it Matters:

Depressive disorders are common mental disorders that occur in people of all ages. Major depressive disorder (MDD) is a leading cause of disability worldwide, affecting an estimated 120 million people.1 The lifelong prevalence is estimated to range from 10%–15%.2 In the United States, the 12‐month prevalence of MDD is 10.4%, with a lifetime prevalence of 20.6%.3

Depression is associated with other chronic medical conditions and increased morbidity and mortality. The mortality risk for suicide in depressed patients is more than 20-fold greater than in the general population.4 Depression is associated with a 60% increased risk of type 2 diabetes, and has been identified as a risk factor for development of cardiovascular disease.5 In addition, depression adversely affects the course, complications and management of other chronic medical illnesses.5 In adolescents, depression can also result in serious long-term morbidities such as generalized anxiety disorder and panic disorder, or lead to engagement in risky behaviors, such as substance use.4 Adolescent-onset depression increases the risk of attempted suicide by five-fold in comparison to non-depressed adolescents. Most adolescents who commit suicide—the third leading cause of death among 15–24-year-olds—have a previous history of depression.5

Depression has long been recognized as a major contributor to disease burden.10 This accounts for an estimated 10% of years lived with disability worldwide, which is three times the impact of diabetes, 8 times the impact of heart disease, and 40 times the impact of cancer.8 These findings underscore the need for attention to depressive disorders and the implementation of effective interventions to reduce their disease burden.

Numerous studies have demonstrated the effectiveness of screening and treatment for depression. Literature has focused on the care processes needed to treat and manage depression in primary care settings, where the majority of depression cases first present.

Studies have found that patient outcomes improve when there is collaborative care between a primary care doctor, case manager and a mental health specialist to screen for depression, monitor symptoms, provide treatment and refer to specialty care as needed.4,9,11 The PHQ-9 is widely used by clinicians in the U.S. and commonly accepted in the behavioral health field as well. Furthermore, the PHQ-9 is quick to complete, score, and is recommended by the International Consortium for Health Outcomes Measurement (ICHOM) as the tool to be used to track depression symptoms in their standard set of outcome measures for depression and anxiety.12

*Adapted with financial support from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) under the CHIPRA Pediatric Quality Measures Program Centers of Excellence grant number U18HS020503, and with permission from the measure developer, Minnesota Community Measurement.

Results – National Averages

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This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.

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. Lépine, J.P., M. Briley. 2011. “The Increasing Burden of Depression.” Neuropsychiatric Disease and Treatment 7(suppl 1):3–7. 
  3. Kern, D.M., C.M. Canuso, E. Daly et al. 2023. “Suicide-Specific Mortality Among Patients With Treatment-Resistant Major Depressive Disorder, Major Depressive Disorder With Prior Suicidal Ideation or Suicide Attempts, or Major Depressive Disorder Alone. Brain Behav 13(8):e3171. Doi:10.1002/brb3.3171 
  4. Korczak DJ, Westwell-Roper C, Sassi R. Diagnosis and Management of Depression in Adolescents. CMAJ 2023;195(21):E739-E746. doi:10.1503/cmaj.220966. 
  5. Garber, J., V.R. Weersing, S.D. Hollon, G. Porta, G.N. Clarke, J.F. Dickerson, … & D.A. Brent. 2018. “Prevention of Depression in At-Risk Adolescents: Moderators of Long-Term Response.” Prevention Science 19, 6–15. 
  6. Birnbaum, H. G., R.C. Kessler, D. Kelley, R. Ben‐Hamadi, V.N. Joish, P.E. Greenberg. 2010. “Employer Burden of Mild, Moderate, and Severe Major Depressive Disorder: Mental Health Services Utilization and Costs, and Work Performance.” Depression and Anxiety 27(1):78–89. 
  7. Cuijpers, P., Stringaris, A., & Wolpert, M. (2020). “Treatment Outcomes for Depression: Challenges and Opportunities.” The Lancet Psychiatry 7(11), 925–7. . 
  8. Thota, A.B., T.A. Sipe, G.J. Byard, C.S. Zometa, R.A. Hahn, L.R. McKnight-Eily, D.P. Chapman et al. 2012. “Collaborative Care to Improve the Management of Depressive Disorders: A Community Guide Systematic Review and Meta-Analysis.” American Journal of Preventive Medicine 42(5):525–38. 
  9. Chu, H., Chen, L., Yang, X., Qiu, X., Qiao, Z., Song, X., … & Yang, Y. 2021. “Roles of Anxiety and Depression in Predicting Cardiovascular Disease Among Patients With Type 2 Diabetes Mellitus: A Machine Learning Approach.” Frontiers in Psychology 12, 645418. 
  10. Moreno-Agostino, D., Y.T. Wu, C. Daskalopoulou, M.T. Hasan, M. Huisman, & M. Prina. 2021. “Global Trends in the Prevalence and Incidence of Depression: A Systematic Review and Meta-Analysis.” Journal of Affective Disorders 281, 235–43. 
  11. Wagner, J., S. Henderson, T.J. Hoeft, M. Gosdin, & L. Hinton. 2022. “Moving Beyond Referrals to Strengthen Late-Life Depression Care: A Qualitative Examination of Primary Care Clinic and Community-Based Organization Partnerships.” BMC health Services Research 22(1), 605. 
  12. International Consortium for Health Outcomes Measurement (ICHOM). 2015. ICHOM Standard Set for Depression & Anxiety. http://www.ichom.org/medical-conditions/depression-anxiety/ 

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