UCSD Performance-Based Skills Assessment: A Valid Measure of Functioning in MDD

Major depressive disorder diagnosis
Major depressive disorder diagnosis
Results confirm the validity of the University of California San Diego Performance-Based Skills Assessment for assessing functional capacity in people with major depressive disorder.

The University of California San Diego Performance-based Skills Assessment (UPSA) reliably assesses functioning among individuals with major depressive disorder and provides a clinically important difference of approximately 6 to 7 points, according to a study recently published in the Journal of Affective Disorders.

Researchers replicated and validated the findings of the CONNECT (ClinicalTrials.gov identifier: NCT01564862; n=602) study by including additional data from the ReMind WORK (ClinicalTrials.gov identifier: NCT02279966; n=152) and ReMind SWITCH (ClinicalTrials.gov identifier: NCT02272517; n=101) studies.

The ReMind Work and ReMind SWITCH studies were double-blind, placebo-controlled, and involved adults with moderate to severe major depressive disorder who were experiencing an episode between 3 to 12 months long at baseline. Participants were randomly assigned to an 8-week course of vortioxetine 10/20 mg, placebo, or a drug such as escitalopram 10/20 mg or paroxetine 20 mg for similar indications. Construct validity was assessed using Pearson correlation coefficients for 5 different measures.

Analysis showed a strong association in the 2 additional studies between UPSA-Brief score and Digit Symbol Substitution Test (r=0.32; P <.0001). However, UPSA-Brief score did not correlate with either Perceived Deficit Questionnaire-20 (r=-0.10; P =.109) or the Montgomery-Åsberg Depression Rating Scale (r=-0.07; P =.302), all of which mirrored the results of the initial validation study.

The range of clinically important difference was 7.1 to 11.2 points for anchor-based methods and 5.5 to 6.1 points for distribution-based methods. The anchor-based method involved finite scores on the Clinical Global Impressions–Improvement scale, while the distribution-based approach approximated the clinically important difference as half of the UPSA-Brief score’s standard deviation. Combining results from all 3 studies resulted in an estimated clinically important difference between 6.4 (distribution-based methods) and 7.0 (anchor-based methods).

The study researchers concluded that “the UPSA provides clinically relevant information for patient functioning in patients with [major depressive disorder] and provides additional support for an estimate of a [clinically important difference] of treatment response of 6–7 points improvement in UPSA score over 8 weeks of treatment in this population….It is a testable hypothesis that the use of such tools (e.g., UPSA) as part of measurement-based care could improve overall health outcomes in [major depressive disorder].”

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Disclosure: Data for this study were from clinical studies sponsored by H. Lundbeck A/S and Takeda Pharmaceuticals Inc. Several authors report associations with pharmaceutical companies. For a full list of author disclosures, visit the reference.


Christensen MC, Sluth LB, McIntyre RS. Validation of the University of California San Diego Performance-based Skills Assessment (UPSA) in major depressive disorder: replication and extension of initial findings [published online November 5, 2018]. J Affect Disord. doi: 10.1016/j.jad.2018.11.034