In a new study published July 15 in the American Journal of Psychiatry, researchers suggest that a checklist of 12 symptoms could help physicians predict which patients are most at risk for having their depression return after an eight-week remission.

The checklist could help physicians individually tailor follow-up visits with their patients who are in remission, reaching out more often to those identified in the checklist as being at higher risk of relapse. Identifying these higher-risk patients is important, as the study database indicated that 16 percent of depressed patients relapsed within six months after remission, and 26 percent within one year.

The study authors include Scientific Council Member Lewis L. Judd, M.D. of UC San Diego and 1991 Distinguished Investigator grantee A. John Rush, M.D. of Duke University, along with Pamela J. Schettler, Ph.D., Senior Statistician at UC San Diego. They looked at the records of 188 patients included in a 31-year follow-up study at five U.S. academic medical centers. These people had been evaluated after at least eight weeks in remission. They were evaluated using the Hopkins Symptom Checklist-90, a questionnaire that measures a variety of mood, cognitive, behavioral and physical symptoms.

The team concluded that 12 symptoms on the Hopkins checklist were the most useful in predicting which patients achieving remission would relapse within the next six months. These items include trouble concentrating, worrying about too many things, feeling self-conscious or inferior to others, having feelings too easily hurt, and feeling low or slow in energy, among others.

The relapse rate was 5.8 percent when the patient had none of the 12 symptoms above a minor level; 16.4 percent when one to five symptoms were present, 34.1 percent when six to nine symptoms were present, and 72.7 percent when 10 or more symptoms were present.

“Despite having achieved full remission,” the authors write, “patients who are more likely to relapse appear to remain in an unstable state that impairs the needed resilience to deal with the ups and downs of daily life.” Hence the potential usefulness of the checklist.