Beyond the Questionnaire: Tracking MDD Progress Through Everyday Conversation

In "Beyond the Questionnaire: Tracking MDD Progress Through Everyday Conversation," Erin Crown, MHS, PA-C, CAQ-Psychiatry details the mix of validated scales and everyday conversation she uses to track progress.

Erin Crown, MHS, PA-C, CAQ-Psychiatry outlines the tools available to monitor depressive symptoms outside of clinical trials, starting with the PHQ family of scales, including the PHQ-2, PHQ-6, and PHQ-9, all standardized and validated for practice use. Even so, she says conversation carries most of the diagnostic weight in her clinic, built on the trust and rapport she has developed with patients over time. She illustrates this with the same isolated patient from the prior episode: rather than relying solely on a scale, she tracked his recovery by asking what he ate for breakfast, lunch, and dinner, and how many aisles he walked through at the grocery store before checking out. These conversational details revealed functional change that no questionnaire directly captures, though she notes that standardized, validated score reductions like those from the PHQ-9 remain important when trying to justify a branded medication to a payer. For suicide risk specifically, Erin Crown uses the Columbia Suicide Severity Rating Scale, which she describes as more thorough than a simple screening question, even if slightly repetitive.

On patient-reported outcomes more broadly, Erin Crown's practice uses social determinants of health screening tools alongside the PHQ-9 and Columbia scale, documenting endorsed items in the clinical note and following up at later visits. She distinguishes this conversational, practice-based approach from her separate role as a principal investigator in clinical trials, where data collection requirements are far more structured and formal. Regardless of role, Erin Crown says she wants to hear directly from the patient about how they are doing, and from the people in their life, because family and friends often notice subtle improvements before the patient does, especially early in the wellness journey when patients themselves may not yet recognize the change taking place.

Up next, in "Who Defines Success? Realistic Goals and Hidden Nonadherence," Dr. Harding and Dr. Citrome take up who should define treatment success, and why adherence is harder to read than it looks.