Outcome Criteria in Antidepressant Drug Trials: Self-Rating versus Observer-Rating Scales

Abstract

An overview of the literature and some findings of the author's own empirical studies lead to the general conclusion that observer rating should be chosen as the principle outcome criterion in antidepressant drug trials. In various situations, however, self-rating scales can provide additional important information for therapy evaluation. The cross-sectional confirmity of observer ratings and self ratings of depression varies to a greater or lesser extent, depending on various background variables. With respect to longitudinal observation the relationship is much closer. Sensitivity for change can be attested not only to observer ratings but also to self ratings.

A new self‐rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale

“…It should be borne in mind that patients and doctors use different frames of reference when they grade the severity of the symptoms (29)(30)(31). The patients have direct access to their present experience, which they are likely to compare to similar experiences in the past.…”

Self-Rating Procedures in the Evaluation of Antidepressants

“…In our own studies of endogenousdepressive and neurotic-depressive inpatients (diagnoses according to ICD-9), in which, among other measures of the severity of de pression, the 'Depressive Syndrome' of the 294 Möller/von Zerssen Self-Rating Procedures in the Evaluation of Antidepressants Inpatient Multidimensional Psychiatric Scale (IMPS) [34] and the depression score of the Paranoid-Depression Scale as well as the score of the Adjective Mood Scale [8,35] were compared at admission (table 1), the correla tions were very low. This result might be explained by the fact that the items included in each of these measures do not closely corre spond with one another [36], Some investigations demonstrate that there is a general tendency for correlations between self-report and interview scales to be substantially higher for ratings after improve ment of psychopathology than during the peak of a depressive episode [13,24,28,37,38], This was found in our own study, too, when comparing the correlations at discharge and at admission (see table 1). Based on data of another study, in which the efficacy of two antidepressive treatments was evaluated by weekly ratings of depression [39], we could demonstrate an increase of the correlation scores over time ( fig.…”

“…This factor o f 'social desirability' is perhaps more impor tant with respect to personality question naires, but there is some evidence that depres sive symptoms are also considered as socially Table 1. Correlation of self-ratings and ratings by psychiatrists in endogenous depressives (n = 159) at admis sion and discharge [36] Ratings by psychiatrists Self-ratings undesirable qualities [13]; (c) the tendency of a certain group of patients (hysterics and some other neurotics) to give responses indic ative of presence and severity of symptoms ('aggravation'), and (d) the tendency of cer tain subjects not to give information about themselves.…”

The validity of self-rated psychotic symptoms in depressed inpatients

“…Self-rated psychotic symptoms were assessed using the SCL-90 score psychoticism (SCL-90 items: 7,16,35,62,77,84,85,87,88,90) and paranoid ideation (SCL-90 items: 8, 18, 43, 98, 76, 83). Both scores were calculated and combined into one single score (SCL psychosis) as described previously [27].…”