Discrepancy between subjective and objective severity in treatment-resistant depression: prediction of treatment outcome.
OBJECTIVE
Identifying predictors of outcome among patients with treatment-resistant depression (TRD) is challenging. We hypothesised that discrepancy between self-rated and observer-rated scales may be a simple way of making such a prediction.


METHODS
102 patients were admitted to a unit specialising in the treatment of resistant depression and underwent fortnightly assessment with clinician-rated (Hamilton Depression Rating Scale-21, HAM-D) and self-rated (Beck Depression Inventory, BDI) measures. All patients had significant depressive symptoms that were treatment resistant, 70% as part of a major depressive disorder and the remainder as part of a bipolar or other disorder. A discrepancy score between the HAM-D and BDI was calculated on admission and its association with patient clinico-demographic factors was determined. A subset of 67 patients remained as inpatients for 40 weeks or until clinical response and were entered into a responder analysis, in which response was defined as ≥50% reduction in admission HAM-D score. The association of the admission BDI-HAM-D discrepancy score with subsequent patient response, was determined.


RESULTS
The magnitude of BDI-HAM-D discrepancy was higher in those with co-morbid personality disorder, lower in those with psychosis and positively correlated with anxiety. High BDI-HAM-D discrepancy score predicted delayed treatment response (odds ratio 5.40, p = 0.005).


CONCLUSIONS
Within TRD, higher discrepancy predicts slower response to treatment independent of objective illness severity; this may be mediated by underlying personality traits and co-morbid anxiety.
Rane
L J
LJ
King's College London, Institute of Psychiatry, Division of Psychological Medicine and Psychiatry, Section of Neurobiology of Mood Disorders, 103 Denmark Hill, London SE5 8AZ, UK. l.rane@kcl.ac.uk
Fekadu
A
A
Wooderson
S
S
Poon
L
L
Markopoulou
K
K
Cleare
A J
AJ
D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012189:Retrospective Studies; D012647:Self-Assessment; D012720:Severity of Illness Index; D013997:Time Factors