TY - JOUR
T1 - Concordance between clinician and patient ratings as predictors of response, remission, and recurrence in major depressive disorder
AU - Dunlop, Boadie W.
AU - Li, Thomas
AU - Kornstein, Susan G.
AU - Friedman, Edward S.
AU - Rothschild, Anthony J.
AU - Pedersen, Ron
AU - Ninan, Philip
AU - Keller, Martin
AU - Trivedi, Madhukar H.
N1 - Funding Information:
Dr. Rothschild received grants or funding from the National Institute of Mental Health, Cyberonics, Takeda, and Wyeth. He is a consultant for Pfizer, GlaxoSmithKline, Forest Laboratories, and Eli Lilly & Company. Royalties include the Rothschild Scale for Antidepressant Tachyphylaxis (RSAT), Clinical Manual for the Diagnosis and Treatment of Psychotic Depression, American Psychiatric Press, 2009.
Funding Information:
Role of funding source: Research supported by Pfizer Research.
Funding Information:
Dr. Dunlop has served as a consultant for Wyeth and Bristol-Myers Squibb and has served on the Speaker’s Bureau for Bristol-Myers Squibb. He has received research support from GlaxoSmithKline, Novartis, Takeda, the National Institute of Mental Health, Ono Pharmaceuticals, and Wyeth.
Funding Information:
This study was sponsored by Wyeth which was acquired by Pfizer Inc in October 2009. Medical writing support for this manuscript was provided by Sally K. Laden, MS, of MSE Communications LLC, and medical editing support was provided by Nicole Hilberth, MS, of Advogent, and this support was funded by Pfizer, formerly Wyeth Research, Collegeville, PA.
PY - 2011/1
Y1 - 2011/1
N2 - We conducted a secondary analysis of data from the Prevention of Recurrent Episodes of Depression With Venlafaxine Extended Release (ER) for Two Years (PREVENT) trial to evaluate whether discrepancies between clinician and patient ratings of depression severity were predictive of response, remission, and recurrence during treatment for a depressive episode. Patients who self-rated depression severity in concordance with the clinician (" concordant patients" ) were defined as having a standardized patient-rated Inventory of Depressive Symptoms-Self Report (IDS-SR30) score minus standardized clinician-rated Hamilton Rating Scale for Depression (HAM-D17) score <1 SD from mean. Non-concordant patients (" underrating patients" [-1 SD], " overrating patients" [+1 SD]) were identified. Cohorts were compared for remission and response on the HAM-D17, Clinician Global Impression--Severity (CGI-S), and IDS-SR30 during acute and continuation therapy and time to recurrence during maintenance therapy. During acute treatment female patients were more likely to overrate their depression severity compared to the clinician; older age predicted overrating during continuation treatment. Overrating patients had a slower onset of response on the HAM-D17 during acute treatment (P=0.004). There were no differences between cohorts for remission or response on the HAM-D17 or CGI-S. Overrating patients at week 10 had lower remission and response rates on the IDS-SR30 during continuation therapy (32% and 50%, respectively; P≤0.001) compared with underrating patients (76%, 77%) or concordant patients (64%, 78%). Patient concordance at the end of continuation therapy did not predict recurrence during maintenance therapy, indicating that patient rating scales may be useful in tracking recurrence during maintenance therapy. Poor agreement between patient- and clinician-ratings of depression severity is primarily a state phenomenon, although it is trait-like for some patients.
AB - We conducted a secondary analysis of data from the Prevention of Recurrent Episodes of Depression With Venlafaxine Extended Release (ER) for Two Years (PREVENT) trial to evaluate whether discrepancies between clinician and patient ratings of depression severity were predictive of response, remission, and recurrence during treatment for a depressive episode. Patients who self-rated depression severity in concordance with the clinician (" concordant patients" ) were defined as having a standardized patient-rated Inventory of Depressive Symptoms-Self Report (IDS-SR30) score minus standardized clinician-rated Hamilton Rating Scale for Depression (HAM-D17) score <1 SD from mean. Non-concordant patients (" underrating patients" [-1 SD], " overrating patients" [+1 SD]) were identified. Cohorts were compared for remission and response on the HAM-D17, Clinician Global Impression--Severity (CGI-S), and IDS-SR30 during acute and continuation therapy and time to recurrence during maintenance therapy. During acute treatment female patients were more likely to overrate their depression severity compared to the clinician; older age predicted overrating during continuation treatment. Overrating patients had a slower onset of response on the HAM-D17 during acute treatment (P=0.004). There were no differences between cohorts for remission or response on the HAM-D17 or CGI-S. Overrating patients at week 10 had lower remission and response rates on the IDS-SR30 during continuation therapy (32% and 50%, respectively; P≤0.001) compared with underrating patients (76%, 77%) or concordant patients (64%, 78%). Patient concordance at the end of continuation therapy did not predict recurrence during maintenance therapy, indicating that patient rating scales may be useful in tracking recurrence during maintenance therapy. Poor agreement between patient- and clinician-ratings of depression severity is primarily a state phenomenon, although it is trait-like for some patients.
KW - Anxiety
KW - Depression
KW - Outcome assessment
KW - Psychiatric status rating scales
KW - Reliability and validity
KW - Treatment outcome
UR - http://www.scopus.com/inward/record.url?scp=78650935825&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78650935825&partnerID=8YFLogxK
U2 - 10.1016/j.jpsychires.2010.04.032
DO - 10.1016/j.jpsychires.2010.04.032
M3 - Article
C2 - 20537348
AN - SCOPUS:78650935825
SN - 0022-3956
VL - 45
SP - 96
EP - 103
JO - Journal of Psychiatric Research
JF - Journal of Psychiatric Research
IS - 1
ER -