According to a study published in the Journal of Affective Disorders, both self-report and clinician rating should be used to fully assess depression in individuals. However, due to agreement between rating measures in symptom domains, self-report is sufficient to evaluate remission of major depressive disorder symptoms.
The investigators of the study examined discrepancies between self-report and clinician rating of individual symptom severity and sought to identify which factors affected agreement between self-reported and clinician-rated severity measures.
The study included 3275 patients with major depressive disorder from the National Survey on Symptomatology of Depression of China. A 62-item questionnaire (in both self-report and clinician-rated versions) was used to evaluate patients’ symptoms related to depression; each question was rated on the 4-point Likert scale. The questions were categorized by 6 major domains: mood (sadness/anhedonia/pessimism), energy (lassitude/activity/interpersonal), anxiety, history, somatic, and other.
In comparing the rating tendency toward self-report or clinician scoring, the χ2 test of independence was used to predict the impact of various factors, including different sources of admission (inpatient vs outpatient), financial status (low vs high), education level (low vs high), and working conditions (poor vs good) among patients.
Absolute agreement with research clinicians was reached in an average 59.6% of participating patients. Of the 62 questions, 45 (72.6%) had moderate positive strength of correlation, while 17 questions (27.4%) had low positive correlation. In 46 of 62 questions (74.2%), there was a tendency of patients to score higher in the self-report version compared with clinician scoring in the clinician-rated version.
Patients and clinicians had the highest percentage of agreement in questions that fell under the history domain (81.0% agreement) followed by the somatic domain (64.7% agreement), but there were more differences in questions about mood, energy, and anxiety (between 54.0% to 55.8% agreement). The most significant factors predicting a difference in patient vs clinician rating — in which the patients rated questions higher than clinicians — was outpatient status, high financial status, poor working conditions, and high education level.
Limitations of the study included the cross-sectional nature of the study design, in which correlation could not be inferred, and the short amount of time between assessment for both versions, which had the potential to increase agreement. Furthermore, survey questions did not include factors such as depression subtype, personality, and rumination.
Considering at least moderate agreement in rating severity of individual symptoms, the investigators of the study concluded that the self-report version of the questionnaire was sufficient to screen, monitor, and detect remission of depressive symptoms. However, the investigators noted that there is tendency for higher self-rating among certain domains, and full assessment of depression severity should take into account both clinician-rated scales and self-reported measures.
This study was sponsored by the National Natural Science Foundation of China, the Ministry of Science and Technology of the People’s Republic of China, Shanghai Municipal Health Bureau, Shanghai Hospital Development Center, and Shanghai Jiao Tong University.
Lyu D, Wu Z, Wang Y, et al. Disagreement and factors between symptom on self-report and clinician rating of major depressive disorder: a report of a national survey in China [published online April 19, 2019]. J Affect Disord. doi: 10.1016/j.jad.2019.04.073