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

• Type of Material: Article
• Authors: Boadie W Dunlop, Emory University; Thomas Li, Wyeth Research; Susan G. Kornstein, Virginia Commonwealth University; Edward S. Friedman, University of Pittsburgh; Anthony J. Rothschild, University of Massachusetts; Ron Pedersen, Wyeth Research; Philip Ninan, Wyeth Research; Martin Keller, Brown University; Madhukar H. Trivedi, University of Texas Southwestern
• Language: English
• Date: 2011-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2010 Elsevier Ltd. All rights reserved.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpsychires.2010.04.032
• Title of Journal or Parent Work: Journal of Psychiatric Research
• ISSN: 0022-3956
• Volume: 45
• Issue: 1
• Start Page: 96
• End Page: 103
• Grant/Funding Information: Dr. Trivedi has received grants/research from the Agency for Healthcare Research and Quality, Corcept Therapeutics, Cyberonics, Meade Johnson, National Alliance for Research in Schizophrenia and Depression, the National Institute of Mental Health, NIDA, Novartis, Pharmacia & Upjohn, Solvay, and Targacept.; This study was sponsored by Wyeth which was acquired by Pfizer Inc in October 2009.; Dr. Friedman has received grant/research support from Northstar, Sanofi Aventis, Novartis, Cyberonics, Medtronics, and the National Institute of Mental Health.; 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.; Dr. Rothschild received grants or funding from the National Institute of Mental Health, Cyberonics, Takeda, and Wyeth.; Dr. Keller has received grants/research from Pfizer and is part of the advisory board for Abbott, Bristol-Myers Squibb, CENEREX, Cyberonics, Cypress, Forest Laboratories, Janssen, Neurotics, Novartis, Organon, and Pfizer.; Dr. Kornstein has received grants/research from the National Institute of Mental Health, Departments of Health and Human Services, Pfizer, Bristol-Myers Squibb, Eli Lilly & Company, Forest Laboratories, Wyeth, Novartis, Sepracor, Boehringer-Ingelheim, Sanofi-Synthelabo, AstraZeneca, and Takeda.; Dr. Dunlop has received research support from GlaxoSmithKline, Novartis, Takeda, the National Institute of Mental Health, Ono Pharmaceuticals, and Wyeth.
• Keywords: Depression; Reliability and validity; Anxiety; Treatment outcome; Outcome assessment; Psychiatric status rating scales
• Research Categories: Psychology, General

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.