Concordance between clinician and patient ratings as predictors of response, remission, and recurrence in major depressive disorder

Boadie W. Dunlop, Thomas Li, Susan G. Kornstein, Edward S. Friedman, Anthony J. Rothschild, Ron Pedersen, Philip Ninan, Martin Keller, Madhukar H. Trivedi

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)96-103
Number of pages8
JournalJournal of Psychiatric Research
Volume45
Issue number1
DOIs
StatePublished - Jan 2011

Fingerprint

Major Depressive Disorder
Recurrence
Depression
Therapeutics
Self Report

Keywords

  • Anxiety
  • Depression
  • Outcome assessment
  • Psychiatric status rating scales
  • Reliability and validity
  • Treatment outcome

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Concordance between clinician and patient ratings as predictors of response, remission, and recurrence in major depressive disorder. / Dunlop, Boadie W.; Li, Thomas; Kornstein, Susan G.; Friedman, Edward S.; Rothschild, Anthony J.; Pedersen, Ron; Ninan, Philip; Keller, Martin; Trivedi, Madhukar H.

In: Journal of Psychiatric Research, Vol. 45, No. 1, 01.2011, p. 96-103.

Research output: Contribution to journalArticle

Dunlop, Boadie W. ; Li, Thomas ; Kornstein, Susan G. ; Friedman, Edward S. ; Rothschild, Anthony J. ; Pedersen, Ron ; Ninan, Philip ; Keller, Martin ; Trivedi, Madhukar H. / Concordance between clinician and patient ratings as predictors of response, remission, and recurrence in major depressive disorder. In: Journal of Psychiatric Research. 2011 ; Vol. 45, No. 1. pp. 96-103.
@article{2e8cfb7aea4e44d78a7483b58351b4c9,
title = "Concordance between clinician and patient ratings as predictors of response, remission, and recurrence in major depressive disorder",
abstract = "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.",
keywords = "Anxiety, Depression, Outcome assessment, Psychiatric status rating scales, Reliability and validity, Treatment outcome",
author = "Dunlop, {Boadie W.} and Thomas Li and Kornstein, {Susan G.} and Friedman, {Edward S.} and Rothschild, {Anthony J.} and Ron Pedersen and Philip Ninan and Martin Keller and Trivedi, {Madhukar H.}",
year = "2011",
month = "1",
doi = "10.1016/j.jpsychires.2010.04.032",
language = "English (US)",
volume = "45",
pages = "96--103",
journal = "Journal of Psychiatric Research",
issn = "0022-3956",
publisher = "Elsevier Limited",
number = "1",

}

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.

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

VL - 45

SP - 96

EP - 103

JO - Journal of Psychiatric Research

JF - Journal of Psychiatric Research

SN - 0022-3956

IS - 1

ER -