Context: Depression is a pervasive and costly medical issue, but little is known about predictors of response to usual care of depression in primary care settings.
Objective: to examine which patient characteristics best predict response to and remission from depression in primary care.
Design: Observational
Setting: 82 primary care clinics across Minnesota
Participants: 792 patients enrolled in primary care clinics participating in DIAMOND
Interventions: Usual (pre-implementation) care for depression
Outcome Assessment: Depression response and remission were measured with the PHQ-9 at 6 months.
Results: Participants tended to be women, white, coupled, and employed. Most had commercial health insurance and good-to-excellent physical health. At baseline, 32% of patients had mild depression, 40% moderate, 20% moderate-to-severe, and 8% severe. Overall, 46% of patients experienced a response and 36% a remission from depression. There were no differences response or remission rates based on gender, age, race/ethnicity, marital status or insurance type. Employed patients were less likely to respond to usual depression care (OR 0.7, p=0.02), but higher income (OR 1.4, p=0.03) and good-to-excellent physical health (OR 1.4, p<0.0001) predicted better response; better health also predicted better remission rates (OR 1.7, p=0.0001). There was no significant association between response and depression severity, but patients who were more severely depressed were less likely to achieve remission (OR 0.1, p<0.0001).
Conclusions: The majority of patients receiving usual depression care settings achieved response or remission. Predictors of response included employment status, income level, and physical health status. Predictors of remission included physical health status and depression severity.