Out of sight, out of mind? High discrepancy between observer- and patient-reported outcome after routine inpatient treatment for depression.
Journal
Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
received:
28
04
2021
revised:
09
08
2021
accepted:
02
01
2022
pubmed:
8
1
2022
medline:
8
3
2022
entrez:
7
1
2022
Statut:
ppublish
Résumé
Divergent outcomes of treatment for depression occur regularly, but often go undetected by clinical judgment alone. To date, no comprehensive studies are available on what the detection rate of divergent outcomes is in routine care. We analyzed a large (N = 20,882) database of clinician-rated and patient-reported outcomes from routine inpatient treatment for depression. There was little agreement (57.7% on the GAF, 7.8% on the CGI-I) between clinician ratings and patients not showing clinically significant change. There was virtually no agreement (0.6% on the GAF, 2% on the CGI-I) between clinician ratings and self-report scales in deteriorated patients. Multiple regression showed that clinician ratings of change were influenced primarily by symptom severity at discharge, rather than change from admission. Only symptom scales were available as patient-reported outcomes, although clinician ratings may be based on other sources of information. In addition, no information was available on clinicians' experience with the rating scales used, nor is it clear how carefully the ratings were made. It can be concluded that failure to achieve treatment success and worsening after routine treatment for depression often go undetected on clinical rating scales, suggesting that such cases frequently remain undetected. Clinicians should generally obtain patient-reported outcomes during treatment to detect these cases.
Sections du résumé
BACKGROUND
Divergent outcomes of treatment for depression occur regularly, but often go undetected by clinical judgment alone. To date, no comprehensive studies are available on what the detection rate of divergent outcomes is in routine care.
METHOD
We analyzed a large (N = 20,882) database of clinician-rated and patient-reported outcomes from routine inpatient treatment for depression.
RESULTS
There was little agreement (57.7% on the GAF, 7.8% on the CGI-I) between clinician ratings and patients not showing clinically significant change. There was virtually no agreement (0.6% on the GAF, 2% on the CGI-I) between clinician ratings and self-report scales in deteriorated patients. Multiple regression showed that clinician ratings of change were influenced primarily by symptom severity at discharge, rather than change from admission.
LIMITATIONS
Only symptom scales were available as patient-reported outcomes, although clinician ratings may be based on other sources of information. In addition, no information was available on clinicians' experience with the rating scales used, nor is it clear how carefully the ratings were made.
DISCUSSION
It can be concluded that failure to achieve treatment success and worsening after routine treatment for depression often go undetected on clinical rating scales, suggesting that such cases frequently remain undetected. Clinicians should generally obtain patient-reported outcomes during treatment to detect these cases.
Identifiants
pubmed: 34995701
pii: S0165-0327(22)00021-0
doi: 10.1016/j.jad.2022.01.019
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
322-325Informations de copyright
Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.