Discrepancies between self-rated depression and observed depression severity: The effects of personality and dysfunctional attitudes

Abstract

Background: Patient self-reports and clinician ratings of depression severity can differ substantially. The aim of the current study was to explore factors associated with discrepancies between depressed patients' Patient Health Questionnaire (PHQ-9) self-reports and clinicians' Hamilton Rating Scale for Depression (HAMD-17) ratings.

Methods: We first computed discrepancy scores defined as the standardized weighted HAMD-17 total score minus the standardized PHQ-9 total score. To assess correlates of inconsistent scores, results of patients with similar standardized scores were removed (i.e., within ½ standard deviation, n = 270). Positive values indicate underreporting (HAMD-17 > PHQ-9), i.e., the underreporting group (n = 200); and negative discrepancy scores indicate overreporting (PHQ-9 > HAMD-17), i.e., the overreporting group (n = 221). We examined the relationship of demographic, dysfunctional attitudes and personality variables to the discrepancies between self and observer rated depression.

Results: There were significant differences in extraversion, psychoticism, neuroticism, dysfunctional attitudes and occupation between the underreporting group and the overreporting group (all p < .05). When controlling for potential confounding variables, being a working professional and having high neuroticism and dysfunctional attitudes were significantly associated with overestimating symptoms of depression (e.g., professional: OR, 2.89; 95% CI, 1.67-5.00; p < .001; high neuroticism: OR, 7.08; 95% CI, 1.47-34.08; p < .001;dysfunctional attitudes: OR, 1.01; 95% CI, 1.00-1.02; p = .030). People with average, or high extraversion tended to underestimate scores (average extraversion: OR, 0.59; 95% CI, 0.37-0.95; high extraversion: OR, 0.48; 95% CI, 0.24-0.98).

Conclusions: This study is the first to use PHQ-9 and HAMD-17 to explore the discrepancies between self and observer rated depression. Discrepancies occurred between the PHQ-9 score and HAMD-17 score, which were related to neuroticism, extraversion, dysfunctional attitudes and being a working professional. Future research should clarify the relationship between these factors and therapeutic effects of treatments, including adverse outcomes.

Keywords: Depression assessment; Discrepancy; HAMD-17; Observer rating; PHQ-9; Self-rating.