Comparison between self-administered depression questionnaires and patients’ own views of changes in their mood: a prospective cohort study in primary care.

Conference:

SAPC ASM 2019 - Exeter

Talk Code:

P1.11

Presenter:

Catherine Hobbs

Co-authors:

Gemma Lewis, Christopher Dowrick, Daphne Kounali, Tim Peters, Glyn Lewis

Author institutions:

Catherine Hobbs (University of Bath), Gemma Lewis (University College London), Christopher Dowrick (University of Liverpool), Daphne Kounali (University of Bristol), Tim Peters (University of Bristol), Glyn Lewis (University College London)

Problem

Self-administered questionnaires are widely used in primary care and other clinical settings to assess the severity of depressive symptoms and monitor treatment outcomes. Qualitative studies have found that changes in questionnaire scores might not fully capture patients’ experience of changes in their mood but there are no quantitative studies of this issue. Aims: We examined the extent to which changes in scores from depression questionnaires disagreed with primary care patients’ perceptions of changes in their mood and investigated factors influencing this relationship.

Approach

Prospective cohort study assessing patients on four occasions, two weeks apart. Patients (N=554) were recruited from primary care surgeries in three UK sites (Bristol, Liverpool and York) and had reported depressive symptoms or low mood in the past year (68% female, mean age 48.3 (SD 12.6)). Main outcome measures were changes in scores on Patient Health Questionnaire (PHQ-9) and Beck Depression Inventory (BDI-II) and the patients’ own ratings of change.

Findings

There was marked disagreement between clinically important changes in questionnaire scores and patient-rated change, with disagreement of 51% (95% CI 46% to 55%) on PHQ-9 and 55% (95% CI 51% to 60%) on BDI-II. Patients with more severe anxiety were less likely, and those with better mental and physical health related quality of life more likely, to report feeling better, having controlled for depression scores.

Consequences

Our results illustrate the limitations of self-reported depression scales to assess clinical change. Clinicians should be cautious in interpreting changes in questionnaire scores without further clinical assessment.

Submitted by:

Catherine Hobbs

Funding acknowledgement:

The study is funded by a National Institute of Health Research (NIHR). The PANDA is independent research commissioned by the National Institute for Health Research Programme Grant for Applied Research (RP-PG-0610-10048). The views expressed in this publication are those of the author(s) and not necessarily those of the sponsor, NHS, the National Institute for Health Research or the Department of Health and Social Care. The funder had no role in the study design, data collection, data analysis, interpretation of data or writing of the report. This work was part supported by the UCLH NIHR Biomedical Research Centre.