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The discrepancy between patients and informants on clinician-rated measures in major depressive disorder: implications for clinical trials and clinical practice

Peselow, Eric D.a; Karamians, Renehb,c; Lord, Mariec,e; Tobia, Gabrielc; IsHak, Waguih Williamc,d

International Clinical Psychopharmacology: March 2014 - Volume 29 - Issue 2 - p 111–115
doi: 10.1097/YIC.0000000000000015
Original Articles

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.

aDepartment of Psychiatry, Richmond University Medical Center and Freedom From Fear, Staten Island, New York

bPepperdine University, Malibu

cDepartment of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center

dDepartment of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, California

eDepartment of Psychiatry and Behavioral Neurosciences, Loyola University Chicago, Chicago, Illinois, USA

Correspondence to Waguih William IsHak, MD, FAPA, Vice Chairman for Education and Research, Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, 8730 Alden Drive, Thalians W-157, Los Angeles, CA 90048, USA Tel: +1 310 423 3515; fax: +1 310 423 3947; e-mail: waguih.ishak@cshs.org

Received August 6, 2013

Accepted September 26, 2013

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