Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive NE 3rd Floor, Atlanta, GA 30329, USA.
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive NE 3rd Floor, Atlanta, GA 30329, USA; Department of Psychology, Emory University, Atlanta, GA, 30329, USA.
J Affect Disord. 2020 Apr 1;266:22-29. doi: 10.1016/j.jad.2020.01.108. Epub 2020 Jan 22.
Calls to implement measurement-based care (MBC) in psychiatry are increasing. A recent Cochrane meta-analysis concluded that there is insufficient evidence that routine application of patient reported outcomes (PROs) improves treatment outcomes for common psychiatric disorders. There is a particular paucity of this information in patients with treatment resistant depression (TRD).
A TRD sample (n = 302) and a treatment-naïve sample with major depression (n = 344) were assessed for the level of agreement in depression severity between two PROs (the Beck Depression Inventory, BDI, and the Quick Inventory of Depressive Symptomatology Self-report, QIDS-SR) and two Clinician Rated (CRs) measures (Hamilton Depression Rating Scale, HDRS, and the Montgomery-Asberg Depression Rating Scale, MADRS).
Correlations between CR and PRO total scores in the TRD sample ranged from 0.57 (HDRS-QIDS-SR) to 0.68 (MADRS-BDI), reflecting a moderate-to-strong relationship between assessment tools. Correlations in the treatment naïve sample were non-significantly lower for most comparisons, ranging from 0.51 (HDRS-QIDS-SR) to 0.64 (MADRS-BDI). Few predictors of discordance between CRs and PROs were identified, though chronicity of the current episode in treatment-naïve patients was associated with greater agreement.
Inter-rater reliability of the clinician interviews was conducted separately within the two studies so we could not determine the reliability between the two groups of raters used in the studies.
Findings generally supported acceptably high levels of agreement between patient and clinician ratings of baseline depression severity. More work is needed to determine the extent to which PROs can improve outcomes in MBC for depression and, more specifically, TRD.
越来越多的人呼吁在精神病学中实施基于测量的护理（MBC）。最近的 Cochrane 荟萃分析得出的结论是，没有足够的证据表明常规应用患者报告的结果（PROs）可以改善常见精神障碍的治疗结果。在治疗抵抗性抑郁症（TRD）患者中，这种信息尤其缺乏。
对 TRD 样本（n=302）和未经治疗的伴有重度抑郁症的样本（n=344）进行评估，以评估两种 PRO（贝克抑郁量表，BDI 和抑郁症状快速自评量表，QIDS-SR）和两种临床评定量表（汉密尔顿抑郁评定量表，HDRS 和蒙哥马利-阿斯伯格抑郁评定量表，MADRS）之间的抑郁严重程度的一致性。
在 TRD 样本中，CR 和 PRO 总分之间的相关性范围为 0.57（HDRS-QIDS-SR）至 0.68（MADRS-BDI），反映了评估工具之间的中度至强关系。在未经治疗的患者样本中，大多数比较的相关性较低且无统计学意义，范围为 0.51（HDRS-QIDS-SR）至 0.64（MADRS-BDI）。仅确定了几个导致 CR 和 PRO 之间不一致的预测因素，尽管在未经治疗的患者中当前发作的慢性与更大的一致性相关。
两项研究分别对临床访谈的组内可靠性进行了评估，因此我们无法确定两项研究中使用的两组评分者之间的可靠性。
研究结果普遍支持患者和临床医生对基线抑郁严重程度的评估具有较高的一致性。需要进一步研究以确定 PROs 在 MBC 中对抑郁症，特别是对 TRD 的改善效果的程度。
