title: Assessment of reliability in the clinical evaluation of depressive symptoms among multiple investigators in a multicenter clinical trial.
abstract: The objective of this work was to determine the severity of depressive symptoms when multiple clinical examiners evaluate a single subject, as preparatory to their participation as evaluators in a clinical trial. Using the 17-item Hamilton Depression Rating Scale (HDRS), 37 psychiatrists independently assessed the videotape of a patient with symptoms of depression. A new measure for the detection of multiple examiners not in consensus (DOMENIC) was used to identify scale items with low reliability and raters with low inter-rater reliability, from among the remaining raters. Overall inter-rater agreement on the full HDRS was 'excellent' (97%). All raters but one showed adequate agreement both on individual items and on total scores. Two of the 17 HDRS symptomatology items had unacceptable levels of inter-rater scoring variability (<70% agreement). The use of DOMENIC allows for the detection of items of low inter-rater reliability and identification of raters that deviate from the group's ratings prior to the beginning of a clinical trial.
authors.affiliation: Department of Psychiatry of Hospital Ramón y Cajal/Universidad de Alcalá, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Baca-García
authors.forename: C
authors.initials: C
authors.lastname: Blanco
authors.forename: J
authors.initials: J
authors.lastname: Sáiz-Ruiz
authors.forename: F
authors.initials: F
authors.lastname: Rico
authors.forename: C
authors.initials: C
authors.lastname: Diaz-Sastre
authors.forename: D V
authors.initials: DV
authors.lastname: Cicchetti
mesh_terms: D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015588:Observer Variation; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012720:Severity of Illness Index