Dunlop Boadie W, McCabe Bhrett, Eudicone James M, Sheehan John J, Baker Ross A
Hum Psychopharmacol. 2014 Nov;29(6):528-36. doi: 10.1002/hup.2428.
In order to inform outcomes assessments in personalized medicine research, we evaluated the level of agreement between self-reported (SR) and clinician-rated (CR) measures of depression severity before and after treatment with an antidepressant medication.
We pooled data from three trials (totaling 2075 patients) assessing the efficacy of antidepressant monotherapy in major depressive disorder. Differences between CR (17-item Hamilton Rating Scale for Depression [HAM-D17]) and SR (30-item Inventory of Depressive Symptomatology-Self-Rated) scale scores were used to determine concordance between CR-SR ratings. The effect of anxiety (HAMD17 anxiety-somatization subscale score ≥7) on SR-CR agreement was also assessed.
The CR-SR scale agreement was good for response (κ = 0.64) and moderate for remission (κ = 0.57). Patients who rated their depression as less severe than the clinician were significantly more likely to respond to treatment than over-reporters (odds ratio = 1.62; 95% confidence interval: 1.17-2.25). Although anxiety did not impact the level of agreement, among patients with SR-CR discordance, high anxiety was associated with over-reporting of depression severity.
The levels of disagreement for response and remission were too high for CR and SR scales to be considered interchangeable for research on patient-level outcomes. Anxiety does not meaningfully impact SR-CR agreement.
为了指导个性化医学研究中的疗效评估，我们评估了在使用抗抑郁药物治疗前后，自我报告（SR）和临床医生评定（CR）的抑郁严重程度测量指标之间的一致性水平。
我们汇总了三项评估抗抑郁单药治疗对重度抑郁症疗效的试验数据（共2075例患者）。使用CR（17项汉密尔顿抑郁评定量表[HAM-D17]）与SR（30项抑郁症状自评量表）评分之间的差异来确定CR-SR评定之间的一致性。还评估了焦虑（汉密尔顿焦虑量表躯体化因子分≥7）对SR-CR一致性的影响。
CR-SR量表在反应方面一致性良好（κ=0.64），在缓解方面一致性中等（κ=0.57）。自我评定抑郁程度低于临床医生评定的患者比高估者对治疗有反应的可能性显著更高（优势比=1.62；95%置信区间：1.17-2.25）。虽然焦虑并未影响一致性水平，但在SR-CR不一致的患者中，高焦虑与抑郁严重程度高估有关。
反应和缓解方面的不一致程度过高，以至于CR和SR量表在患者水平疗效研究中不能被视为可互换的。焦虑对SR-CR一致性没有显著影响。
