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Predicting disagreement between physicians and patients on depression response and remission

Cunningham, Janet L.a; Wernroth, Lisab; von Knorring, Larsa; Berglund, Larsb; Ekselius, Lisaa

International Clinical Psychopharmacology: May 2013 - Volume 28 - Issue 3 - p 134–140
doi: 10.1097/YIC.0b013e32835ff2a8

Demographic, personality, and disease-related factors all contribute when patients disagree with physicians on the severity of subjective symptoms. This study aims to create a model, on the basis of patient factors at treatment initiation, for longitudinal prediction of disagreement on treatment response and remission in depressed patients. Four hundred patients with major depressive disorder were studied during a clinical drug trial. Repeated assessments with the Montgomery–Åsberg Depression Rating Scale (MADRS) and the self-rating version (MADRS-S) were used to indicate response or remission. Factors at baseline and week 2 were tested for inclusion in a model for the prediction of discordance on remission and response between patients and physicians at week 8. The models were then tested, in the same population, at weeks 12, 16, and 24. Model AUCs ranged from 0.71 to 0.74 for week 8. The models that were validated at weeks 12, 16, and 24 indicated stability in the predictive value of the models. The risk for longitudinal disagreement in the evaluation of depression treatment response and remission in clinical practice and drug trials can be predicted using factors at study initiation and at week 2.

aDepartment of Neuroscience, Psychiatry Unit

bUppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden

Janet L. Cunningham and Lisa Wernroth contributed equally to the writing of this article.

Correspondence to Janet L. Cunningham, MD, PhD, Department of Neuroscience, Uppsala University, Entrance 15, 3rd floor, SE-751 85 Uppsala, Sweden Tel: +46 18 611 5243; fax: +46 18 515810; e-mail:

Received November 21, 2012

Accepted February 7, 2013

© 2013 Lippincott Williams & Wilkins, Inc.