Background:
The Black Dog Institute Depression Clinic provides comprehensive clinical assessment and management strategies, operating to a subtyping diagnostic model. The study aimed to determine whether baseline clinical assessment was predictive of short-term outcome for patients referred with a depressive disorder. Factors contributing to outcome were identified, and the utility of a subtyping approach was discussed.
Methods:
A consecutive series of 85 patients referred to the clinic completed the computerized mood assessment program, followed by interview with the assessing psychiatrist. Prognostic judgments were made reflecting clinical factors (eg disorder type, previous therapy response). Quantitative and qualitative analyses of other contributory factors were undertaken to assess impact on outcome.
Results:
Global assessment of outcome at baseline was predictive of short-term outcome, while outcome trajectories were influenced for those who did not receive (or were unable to continue with) recommended treatments. Comparably high rates of improvement were evident in those with bipolar, melancholic and nonmelancholic subtypes, and somewhat lower in those diagnosed with ‘secondary depression’. Other factors influencing outcome included referral source (ie psychiatrist vs. general practitioner), degree of recommendation uptake and implementation of psycho-tropic drug strategies.
Conclusions:
Improvement rates were high in a clinic weighting a subtyping diagnostic approach to shaping pluralistic management plans. Nonetheless, the absence of a comparator service disallows firm conclusions. These results will guide further definitive study designs.
