The level of agreement between reports made by patients and clinicians is a crucial factor, as psychiatric providers face pressure to implement measurement-based care. A comparison of common assessment tools in a cohort of patients with treatment-resistant depression (TRD) found acceptably high levels of agreement between patient and clinician ratings of baseline severity, according to study results published in the Journal of Affective Disorders.
Rachel Hershenberg, PhD, of the department of psychiatry and behavioral sciences, Emory University School of Medicine, Atlanta, Georgia, and colleagues collected data from patients aged ≥18 years in a TRD clinical research program. They assessed the level of agreement in depression severity between 2 patient-reported outcomes, the Beck Depression Inventory (BDI) and Quick Inventory of Depressive Symptomatology Self-report (QIDS-SR), and 2 clinician-rated measures, the Hamilton Depression Rating Scale (HDRS) and Montgomery-Asberg Depression Rating Scale (MADRS). The sample included patients with TRD (n=302; mean age, 53.4±16.18 years; 57% women) and treatment-naïve patients with major depression (n=344; mean age, 39.96±11.65 years; 57% women).
Correlations between clinician-rated and patient-reported measures in the TRD sample reflected a moderate-to-strong relationship between assessment tools (HDRS vs QIDS-SR: r, 0.57; and MADRS vs BDI: r, 0.68). In the treatment naïve sample, these relationships were slightly lower for most comparisons (HDRS vs QIDS-SR: r, 0.51; and MADRS vs BDI: r, 0.64). Researchers found that current episode chronicity predicted stronger correlations between clinician and physician measures in treatment naïve patients. For both groups, there was a greater correlation between the 2 clinician-rated scales (TRD, r = .83; treatment-naïve r = .77) and patient-reported outcomes (TRD, r = .81, treatment-naïve r = .72).
A study limitation was the lack of follow-up to evaluate levels of concordance during the course of treatment in the TRD sample, as correlations between patient-reported outcomes and clinician ratings may have changed between subsequent assessments.
“We conclude that for [management-based care], using [patient-reported outcomes] can suffice for patients with refractory depression. Our findings suggest that the BDI has slightly higher correlations with [clinician ratings] than the QIDS-SR, though this result requires replication in other datasets,” the researchers wrote. “A consideration favoring the clinical utility of the QIDS-SR or the Patient Health Questionnaire-9…as [patient reported outcomes] over the BDI for use in [management-based care] is the absence of usage fees for those instruments,” they added.
Reference Hershenberg R, McDonald WM, Andrea Crowell A, et al. Concordance between clinician-rated and patient reported outcome measures of depressive symptoms in treatment resistant depression. J Affect Disord. 2020;266:22-29.