Large-scale screening and monitoring in integrated primary care and behavioral health care settings is a natural application of this work and is already in practice in several major institutions. Below are just a handful of the current and past applications of the CAT-MH® and K-CAT®.
SEE JOURNEY MAPUCLA DEPRESSION GRAND CHALLENGE
UCLA is committing its full interdisciplinary resources through 25 departments to reduce the burden of depression by 50% by 2050. Their research study of 100,000 participants will be the largest study ever of its kind and will focus on identifying the genetic, biological, cognitive, social and environmental factors associated with depression.
They will use the CAT-MH® to screen and measure study participants. 1.8 million subjects will be screened for major depressive disorder using the CAD-MDD and then the final registry of 100,000 patients will be monitored for changes in the severity of depression over a 10 year period. UCLA screens and measures incoming freshmen with the CAT-MH® and provides iCBT (internet cognitive behavioral therapy) via a phone app and peer counseling for those with mild severity. More severely ill students are triaged to student health, psychiatry department or the emergency department.
DEEP BRAIN SIMULATION SURGERY
A major research hospital has a patient with refractory depression. They sought the quickest, most accurate ability to measure changes in the patient’s severity of depression in real time during neurosurgery where an electrode was implanted in the patient’s brain and stimulated with a DBS (Deep Brain Stimulator). The neurosurgeon consulted the psychiatrist working on the case and determined that the only suitable measurement tests would be the CAT-MH®. During the procedure (while the patient was in the MRI machine) the doctors administered the CAT-DI (Computerized Adaptive Test – Depression Inventory) both before and after the electrode was stimulated as a way of verifying the correct placement of the implanted electrode (by short-term changes in depressive severity) to enhance the potential for success. Follow-up measurements were obtained remotely via an e-mail prompt directly to the subject over the past 6 months resulting in 93 daily measurements which were completed (See 2017 Attached Article). Changes in levels of electrical stimulation through the device are monitored in real-time based on the daily depressive severity measurement. This study represents the ultimate example of measurement-based treatment.
PERINATAL SCREENING
At NorthShore University Health System, the department of OB/GYN completed two studies using the CAT-MH® for the measurement of perinatal depression, anxiety, mania, and suicidality. (See publications Kim et al. 2016) has examined whether certain symptoms that are good discriminators of high and low levels of depression, anxiety and mania in a psychiatric population may be biased in a perinatal population due to symptoms associated with pregnancy and childbirth that are unrelated to depression. We have identified these symptoms and have eliminated them from the perinatal version of the CAT-MH® tests. The second study examined the compliance of pregnant women screening for depression using the CAT-MH® based on a simple e-mail prompt versus usual care. The study found dramatically increased rates of compliance for mental health screening relative to usual care.
NorthShore University Health System has now implemented the use of the perinatal version of CAT-MH® for all pregnant women at their facilities.
UNIVERSITY OF CHICAGO EMERGENCY DEPARTMENT
The University of Chicago completed a CAT-MH® study of 1,000 patients in the emergency department (ED) who came in for a non-psychiatric indication. They were screened for depression using the CAD-MDD, measured for depression severity using the CAT-DI and suicide risk. 22% of the patients screened positive for MDD and 7% were in the moderate to severe range in need of immediate treatment. 3% generated a suicide warning based on both ideation and intent, plan or recent suicidal behavior. None of these 30 patients were identified by the ED physicians. Among those patients with moderate to severe depression, the rates of ED visits and hospitalizations were double in the following year (prospectively measured) relative to those who did not meet criteria for MDD. The cost to our healthcare system of not identifying and treating patients with depression is enormous.
