Out of sight, out of mind? High discrepancy between observer- and patient-reported outcome after routine inpatient treatment for depression

Abstract

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.