Are self-report scales as effective as clinician rating scales in measuring treatment response in routine clinical practice?

Objective: Recent treatment guidelines have suggested that outcome should be measured in routine clinical practice. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared three self-report scales of depressive symptoms and the two most widely used clinician administered scales in treatment studies in their sensitivity to change and evaluation of treatment response in depressed patients treated in routine practice.

Methods: At baseline and 4-month follow-up 153 depressed outpatients with DSM-IV MDD completed the Clinically Useful Depression Outcome Scale (CUDOS), Quick Inventory of Depressive Symptomatology-Self-report version (QIDS-SR), and Patient Health Questionnaire (PHQ-9).

A clinically useful self-report measure of psychiatric patients' satisfaction with the initial evaluation.

Patient satisfaction is one component of the quality of care. Studies of satisfaction in samples of established patients are biased because dissatisfied patients are more likely to have dropped out of treatment. We, therefore, sought to develop a new instrument assessing patients' satisfaction with the initial psychiatric evaluation.

Identifying Remission From Depression on 3 Self-Report Scales.

Objective: Advocates of measurement-based care approaches toward treatment recommend the use of self-report questionnaires. Many self-report scales have been developed to measure the severity of depression. Because of the significance accorded remission by experts, it is important to compare different scales in their identification of remitted patients.

Scoring rules and rating formats of Self-report Depression Questionnaires: a comparison of approaches.

Self-report measures of depression differ in their construction and scoring rules. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we tested the hypothesis that the loss of information due to scoring rules or rating formats reduces the validity of depression severity assessment. One hundred fifty-three outpatients with DSM-IV major depressive disorder (MDD) who presented for treatment or who were in ongoing treatment and had their medication changed due to lack of efficacy completed the Clinically Useful Depression Outcome Scale (CUDOS), Quick Inventory of Depressive Symptomatology (QIDS) and Remission from Depression Questionnaire (RDQ) at the initiation of treatment and 4 month follow-up.

Speaking a more consistent language when discussing severe depression: a calibration study of 3 self-report measures of depressive symptoms.

Objective: We recently found marked disparities between 3 self-report scales that assess the DSM-IV criteria for major depressive disorder in the percentage of depressed outpatients considered to have severe depression. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to calibrate the measures against a clinician-rated criterion standard and to establish a cutoff point on each scale that identifies a similar prevalence of severe depression and increases the level of agreement between the scales in identifying severe depression.

Method: 353 depressed outpatients (DSM-IV) completed the Clinically Useful Depression Outcome Scale, Quick Inventory of Depressive Symptomatology, and Patient Health Questionnaire from June 2010 to January 2013.

The remission from depression questionnaire as an outcome measure in the treatment of depression.

Background: The Remission from Depression Questionnaire (RDQ) assesses multiple domains considered by depressed patients to be relevant to the construct of remission. The present study is the first to examine the validity of the RDQ as an outcome measure.

Methods: One hundred fifty-three depressed patients who presented for treatment, or who were in ongoing treatment and had their medication changed, were evaluated at baseline and at 4-month follow-up.

Anxiety symptoms among remitted depressed outpatients: prevalence and association with quality of life and psychosocial functioning.

Background: Prior studies of remission from depression have only examined the impact of residual depressive, but not anxiety, symptoms. Given that anxiety comorbidity in currently depressed patients is common and is associated with poorer outcomes, residual anxiety symptoms may play a significant role in remitted patients' well-being and vulnerability to relapse. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the frequency of residual anxiety symptoms among depressed outpatients in remission based on the HAM-D and associations among residual anxiety, psychosocial functioning and quality of life.

Determining severity subtypes of depression with a self-report questionnaire.

The American Psychiatric Association's recently revised guidelines for the treatment of major depressive disorder indicated that it is important to consider symptom severity in initial treatment selection. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we conducted two studies of psychiatric outpatients examining the correlates of severity classification based on a self-report depression scale. The first sample consisted of 470 depressed outpatients who completed the Clinically Useful Depression Outcome Scale (CUDOS) and measures of psychosocial morbidity at the time of presentation.

A new type of scale for determining remission from depression: the Remission from Depression Questionnaire.

Current standards for treating major depressive disorder (MDD) recommend that achieving remission should be considered the principal goal of treatment. Recent research suggests that the symptom-based definitions of remission used in efficacy studies do not adequately reflect the perspective of depressed patients receiving treatment in routine clinical settings. We developed the Remission from Depression Questionnaire (RDQ) to capture the broader array of domains considered by patients to be relevant to the construct of remission--symptoms of depression, nondepressive symptoms, features of positive mental health, coping ability, functioning, life satisfaction and a general sense of well-being.

How can we use depression severity to guide treatment selection when measures of depression categorize patients differently?

Objective: Treatment guidelines for depression suggest that severity should be taken into account when initiating treatment. If clinicians are to consider illness severity in selecting among treatment options for depression, then it is important to have reliable, valid, and clinically useful methods of distinguishing between levels of depression severity. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared 3 self-report scales that assess the DSM-IV criteria for major depressive disorder on the basis of how these scales distribute patients into severity categories.

Symptom differences between depressed outpatients who are in remission according to the Hamilton Depression Rating Scale who do and do not consider themselves to be in remission.

Objective: Remission is usually defined as a score below a predetermined cutoff on a symptom severity scale. Depressed patients' global perception of their remission status only partially overlaps with scale-based definitions of remission. Patients' self-perceived remission status is likely to impact on their desire for modification in their treatment.

How should residual symptoms be defined in depressed patients who have remitted?

Symptomatic remission has been defined as a complete or near-complete absence of symptoms. Just as the distinction between remitters and nonremitters among treatment responders has clinical significance, the distinction between a complete and near-complete absence of symptoms itself might be important. Recent studies have reported a high frequency of residual symptoms in patients who are presumably in remission, and this raises questions about how residual symptoms are defined.

Why do some depressed outpatients who are not in remission according to the hamilton depression rating scale nonetheless consider themselves to be in remission?

Background: In treatment studies of depression, remission is typically defined narrowly-based on scores on symptom severity scales. Patients treated in clinical practice, however, define the concept of remission more broadly and consider functional status, coping ability, and life satisfaction as important indicators of remission status. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined how many mildly symptomatic depressed patients in ongoing treatment who did not score in the remission range on the 17-item Hamilton Depression Rating Scale (HAMD) nonetheless considered themselves to be in remission from their depression.

Why do some depressed outpatients who are in remission according to the Hamilton Depression Rating Scale not consider themselves to be in remission?

Objective: In treatment studies of depression, remission is typically defined narrowly, based on scores on symptom severity scales. Patients treated in clinical practice, however, define the concept of remission more broadly and consider functional status, coping ability, and life satisfaction as important indicators of remission status. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined how many depressed patients in ongoing treatment who scored in the remission range on the 17-item Hamilton Depression Rating scale (HDRS) did not consider themselves to be in remission from their depression.

Determining remission from depression on two self-report symptom scales: a comparison of the Quick Inventory of Depressive Symptomatology and the Clinically Useful Depression Outcome Scale.

To answer fundamental questions regarding the effectiveness of treatments for depression in real-world clinical practice, it is necessary to incorporate the measurement of outcome. Self-report questionnaires are a cost-effective option to systematically, reliably, and validly evaluate clinical status because they are inexpensive in terms of professional time needed for administration, and do not require special training for administration. While there are many self-administered depression scales, only a limited number cover all of the diagnostic criteria for major depressive disorder (MDD) and have had cutoff scores derived corresponding to the Hamilton Depression Rating Scale (HAM-D) definition of remission.

Further evidence that the cutoff to define remission on the 17-item Hamilton Depression Rating Scale should be lowered.

Background: In 1991, the recommendations of a consensus conference were that a cutoff of 7 on the 17-item Hamilton Depression Rating Scale (HAM-D) be used to define remission from depression, and since then this has been the most commonly used definition of remission. The cutoff was not derived from empirical study. In the present report from the MIDAS project, we examined the level of current psychosocial morbidity in depressed patients identified as being in remission according to different thresholds on the 17-item HAM-D.

Depressed patients' perspectives of 2 measures of outcome: the Quick Inventory of Depressive Symptomatology (QIDS) and the Remission from Depression Questionnaire (RDQ).

Background: Current operational definitions of remission, at their root, are exclusively symptom-based and therefore limited in scope. In this report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we examined patient acceptability of a new measure, the Remission from Depression Questionnaire (RDQ), a scale designed to capture a broader array of domains patients consider relevant to the construct of remission. Patient acceptance of the RDQ was compared with that of the Quick Inventory of Depressive Symptomatology (QIDS), the instrument used to measure outcome in the Sequenced Treatment Alternatives to Relieve Depression study.

Underrecognition of clinically significant side effects in depressed outpatients.

Objective: The presence of medication side effects is one of the most frequent reasons depressed patients discontinue medication, and premature discontinuation of medication is associated with poorer outcome in the treatment of depression. Despite the clinical importance of detecting side effects, few studies have examined the adequacy of their detection and documentation by clinicians. We are not aware of any studies comparing psychiatrists' clinical assessments to a standardized side effects checklist in depressed patients receiving ongoing treatment in clinical practice.

Remission in depressed outpatients: more than just symptom resolution?

Objective: In treatment studies of depression remission is defined according to scores on symptom severity scales. Normalization of functioning has often been mentioned as an important component of the definition of remission, though it is not used to identify remitted patients in studies of treatment efficacy. Conceptually, the return of normal functioning should be as fundamental to the concept of remission as is symptom resolution because the presence of both symptoms and impaired functioning are core constructs in the diagnosis of mental disorders.

Presurgical psychiatric evaluations of candidates for bariatric surgery, part 1: reliability and reasons for and frequency of exclusion.

Objective: Many bariatric surgery programs include psychiatric evaluations as part of the pre-operative screening procedure. Surveys of surgeons and mental health professionals have found variability in opinion regarding what psychosocial problems warrant denial of clearance for surgery. Few studies have reported the number of patients who are not cleared for surgery due to psychiatric reasons, and no study has reported the reliability of decision making.

Developing brief scales for use in clinical practice: the reliability and validity of single-item self-report measures of depression symptom severity, psychosocial impairment due to depression, and quality of life.

Objective: Reliable, valid, user-friendly measurement is necessary to successfully implement an outcomes evaluation program in clinical practice. Self-report questionnaires, which generally correlate highly with clinician ratings, are a cost-effective assessment option. However, even self-administered questionnaires can be burdensome to patients because many are lengthy.

The impact of gender, age and depressed state on patients' perspectives of remission.

Background: Current standards for treatment outcome from major depression assess remission solely from the vantage point of symptom resolution. Recent evidence, however, suggests that depressed patients consider factors beyond symptom resolution as important for defining remission. The goal of this study was to examine the influence of three predictors on patients' views of factors important for achieving remission: gender, age and current depressed state (i.

Validity of a self-report depression symptom scale for identifying remission in depressed outpatients.

In treatment studies of depression, remission is usually defined by scoring less than a threshold value on an interview-based measure of depression severity such as the Hamilton Rating Scale for Depression (HRSD). Although it has been recommended that measures such as the HRSD be used by clinicians in clinical practice to evaluate remission status, the time demands of clinical practice limit the feasibility of this suggestion. Self-report questionnaires are a cost-effective option to thoroughly, systematically, reliably, and validly evaluate clinical status because they are inexpensive in terms of professional time needed for administration and do not require special training for administration.

Discordance between self-reported symptom severity and psychosocial functioning ratings in depressed outpatients: implications for how remission from depression should be defined.

The diagnosis of depression is based on the presence of symptoms along with functional impairment. One might therefore expect the definition of remission of depressive disorder to be based on the resolution of both symptoms and functional impairments. This, however, is not how the field has been defining remission.

How should remission from depression be defined? The depressed patient's perspective.

Objective: Although experts in the treatment of depression have suggested that achieving remission is the primary goal of treatment, questions remain about how remission should be defined. In antidepressant efficacy trials, remission is defined according to scores on symptom severity scales. Normalization of functioning is often mentioned as an important component of remission, although it is not used to identify patients with remission in treatment studies.