Periodic use of brief patient self-report questionnaires during treatment for depression can help clinicians recognize substance abuse problems that had been previously missed, according to a presentation at the Tenth Annual Disease Management Congress.

An American study involving 14,923 patients revealed that more than 11 percent of adults and 17 percent of adolescents diagnosed with depression reported substance-abuse problems on patient-completed outcome questionnaires. However, in 70 percent of those cases, the therapist's assessment was that no substance abuse problem existed.

The data also revealed that 40 percent of patients who reported substance abuse problems showed no improvement on substance-abuse items over the course of treatment, and at the same time, they showed virtually no improvement on other depression-related symptoms.

However, for the 60 percent of patients who reported improvement on substance-abuse items, the outcome for depression was very good. In fact, patients reporting a reduction in substance abuse showed greater improvement in depression and daily function than the average patient treated for depression. This held for adults and adolescents.

The implications of the data suggest that unless substance abuse is identified and treated by a clinician, a successful outcome for depression will be difficult to achieve.

"If vital information like co-existing substance abuse is not identified by a clinician providing treatment for depression, a patient's chance of recovery is significantly reduced," said Edward Jones, PhD, presenter. "An outcome-informed model for behavioral health helps clinicians see how their patients are responding to treatment so that modifications to the treatment plan can be made in a timely manner."

The depression sample consisted of 85 percent adults and 15 percent minors. The sample included episodes of care between Jan. 1, 1999, and Sept. 30, 2004.

The patient self-report tool used to gather data was the Life Status Questionnaire (LSQ), a 30-question instrument for adults, and a similar tool for young children and adolescents, called the Y/LSQ. At least two Y/LSQs were completed during treatment, with no more than 180 days lapsing between any two questionnaires.