Aikens James E, Klinkman Michael S, Sen Ananda, Nease Donald E
Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Int J Psychiatry Med. 2015;50(4):383-97. doi: 10.1177/0091217415612734. Epub 2015 Nov 2.
The Remission Evaluation and Mood Inventory Tool (REMIT) is a practical 5-item self-report measure of key positive mood states associated with recovering from depression, as distinct from depressive symptoms per se. The study goal was to identify a clinically useful threshold for interpreting REMIT responses in the context of mild to moderate depressive symptoms.
This was a secondary analysis of a cross-sectional dataset initially used to develop and validate the REMIT. Primary care patients being treated for depressive symptoms of either mild or moderate severity (n = 247 and 240, respectively) rated their perceived degree of depression remission prior to completing the Patient Health Questionnaire-8 (PHQ-8) and the REMIT. We summed the totals of the latter two measures to form the PHQ + REMIT index.
Receiver Operating Characteristics analysis indicated that the PHQ + REMIT threshold ≥ 13 was associated with good sensitivity (92%) and acceptable specificity (43%) to the absence of patient-perceived remission. In contrast, the PHQ had only 21% specificity at this sensitivity level. Area under the curve was 0.815 (95% C.I.: 0.765-0.865), which was significantly greater than that of the PHQ-8 alone (area under the curve = 0.745, 95% C.I.: 0.691-0.805, p(diff) = 0.0002). Threshold performance was unaffected by adjustment for demographic characteristics and variation in remission percentage. Compared with standard symptom-based classification, using the REMIT reclassified 27% of mildly symptomatic patients as remitted.
Using the REMIT with patients who have mild to moderate depressive symptoms improves the assessment of patient-perceived remission, which is indicated by a summed PHQ + REMIT index of less than 13. Longitudinal research is needed to test whether this broadened patient-centered approach to assessing remission improves clinical decision making and long-term outcomes.
缓解评估与情绪量表工具（REMIT）是一种实用的5项自评量表，用于测量与从抑郁症康复相关的关键积极情绪状态，与抑郁症状本身不同。本研究的目标是确定一个在轻度至中度抑郁症状背景下解释REMIT反应的临床有用阈值。
这是对一个横断面数据集的二次分析，该数据集最初用于开发和验证REMIT。正在接受轻度或中度抑郁症状治疗的初级保健患者（分别为n = 247和240）在完成患者健康问卷-8（PHQ-8）和REMIT之前，对他们感知到的抑郁缓解程度进行评分。我们将后两项测量的总分相加，形成PHQ + REMIT指数。
受试者工作特征分析表明，PHQ + REMIT阈值≥13与对患者未感知到缓解的良好敏感性（92%）和可接受的特异性（43%）相关。相比之下，在这个敏感性水平下，PHQ的特异性仅为21%。曲线下面积为0.815（95%置信区间：0.765 - 0.865），显著大于单独的PHQ-8（曲线下面积 = 0.745，95%置信区间：0.691 - 0.805，p（差异）= 0.0002）。阈值性能不受人口统计学特征调整和缓解百分比变化的影响。与基于标准症状的分类相比，使用REMIT将27%有轻度症状的患者重新分类为已缓解。
对有轻度至中度抑郁症状的患者使用REMIT可改善对患者感知到的缓解情况的评估，这通过PHQ + REMIT指数总和小于13来表明。需要进行纵向研究来检验这种以患者为中心的更广泛的缓解评估方法是否能改善临床决策和长期结果。
