The discrepancy between patients and informants on clinician-rated measures in major depressive disorder

Abstract

Clinician-rated measures are used in clinical trials and measurement-based clinical care settings to assess baseline symptoms and treatment outcomes of major depressive disorder (MDD), with a widely held dictum that they are sufficient in assessing the patient's clinical status. In this study, we examined clinician-rated measures of depressive and global symptom severity, obtained by interviewing patients as well as informants in an attempt to examine the potential difference or similarity between these two sources of information. The sample consisted of 89 treatment seeking, DSM-IV diagnosed MDD outpatients treated between 1995 and 2004. The clinician-rated measures used included the Montgomery Åsberg Depression Rating Scale (MADRS), and the Clinical Global Impression Scale (CGI) for Severity. The scores of the clinician-rated measures collected from patients' interviews were compared with those collected from informants' interviews. Clinician-rated scores, collected by interviewing patients, were significantly higher and indicative of greater symptom severity when compared with those collected by interviewing informants. This was true for both the MADRS before (P<0.0001) and after treatment scores (P<0.0001), as well as the CGI before (P<0.0001) and after treatment scores (P<0.0001). Consistently involving informants and the time/burden it takes for them to participate might not be practical in MDD clinical trials or everyday clinical care. The discrepancies observed between the clinician-rated scores obtained from patients and informants emphasize the importance of incorporating collateral information during the assessment and rating of depressive symptom severity in both clinical trials as well as in clinical practice.

Systematic Review and Meta-analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety

“…30,[94][95][96] The moderator analysis suggested that, in line with previous research, informant perspective moderates outcomes, with clinician reports generally documenting greater improvements than self-or parent-reports. 97 This highlights the need to ensure the views of patients themselves are considered wherever possible if patient shared decisions and empowerment are to be made a reality. 98 Problem type also moderated outcomes, with better outcomes for studies focused on depression than those for anxiety.…”

In Brief, Look Sharp: Short Form Assessment in the Geriatric Setting

“…Examples include a brief assessment of social vulnerability (Social Vulnerability Scale; Pinsker, Stone, Pachana, & Greenspan, ; Pinsker, McFarland, & Stone, ) and an informant rating of cognitive decline (Informant Questionnaire on Cognitive Decline in the Elderly [IQCODE]; Jorm, ; Jorm & Jacomb, ). Similarly, providing a person with dementia the opportunity to comment on his or her subjective levels of anxiety, either through the use of a self‐rated assessment tool (e.g., Rating Anxiety in Dementia [RAID]; Shankar et al., ) or through simple interview questions, can assist with overcoming the poor congruence between informant and patient reports of affective symptoms (Peselow, Karamians, Lord, Tobia, & IsHak, ).…”

Depressive Störungen

“…Ein Beispiel ist der "Computerized Adaptive Diagnostic Test for Major Depressive Disorder" (CAD-MDD; Gibbons et al 2013). Beachtung verdient eine neuere Studie, wonach durch Kliniker erhobene MADRSund Clinical-Global-Impression(CGI)-Skalenwerte signifikant höher waren als durch Partner oder Angehörigeninterviews erhobene Ratings (Peselow et al 2013).…”