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

摘要

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-SR) score minus standardized clinician-rated Hamilton Rating Scale for Depression (HAM-D) 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-D, Clinician Global Impression--Severity (CGI-S), and IDS-SR 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-D during acute treatment (P=0.004). There were no differences between cohorts for remission or response on the HAM-D or CGI-S. Overrating patients at week 10 had lower remission and response rates on the IDS-SR during continuation therapy (32% and 50%, respectively; P