Clinical vs. self-report versions of the quick inventory of depressive symptomatology in a public sector sample

https://doi.org/10.1016/j.jpsychires.2006.04.001Get rights and content

Abstract

Objectives

Recent work using classical test theory (CTT) and item response theory (IRT) has found that the self-report (QIDS-SR16) and clinician-rated (QIDS-C16) versions of the 16-item quick inventory of depressive symptomatology were generally comparable in outpatients with nonpsychotic major depressive disorder (MDD). This report extends this comparison to a less well-educated, more treatment-resistant sample that included more ethnic/racial minorities using IRT and selected classical test analyses.

Methods

The QIDS-SR16 and QIDS-C16 were obtained in a sample of 441 outpatients with nonpsychotic MDD seen in the public sector in the Texas Medication Algorithm Project (TMAP). The Samejima graded response IRT model was used to compare the QIDS-SR16 and QIDS-C16.

Results

The nine symptom domains in the QIDS-SR16 and QIDS-C16 related well to overall depression. The slopes of the item response functions, a, which index the strength of relationship between overall depression and each symptom, were extremely similar with the two measures. Likewise, the CTT and IRT indices of symptom frequency (item means and locations of the item response functions, bi were also similar with these two measures. For example, sad mood and difficulty with concentration/decision making were highly related to the overall depression severity with both the QIDS-C16 and QIDS-SR16. Likewise, sleeping difficulties were commonly reported, even though they were not as strongly related to overall magnitude of depression.

Conclusion

In this less educated, socially disadvantaged sample, differences between the QIDS-C16 and QIDS-SR16 were minor. The QIDS-SR16 is a satisfactory substitute for the more time-consuming QIDS-C16 in a broad range of adult, nonpsychotic, depressed outpatients.

Section snippets

Objectives

The accurate, rapid, and cost-efficient measurement of depressive symptoms serves both clinical and research purposes. Clinicians can gauge the benefit of treatment and make timely adjustments in the treatment plan. Research, on the other hand, can be made less costly if such measures are available. The quick inventory of depressive symptomatology (QIDS) is a 16-item scale that measures each of the nine symptom domains that define a major depressive episode based on DSM-IV TR (American

Subjects

TMAP was conducted in accordance with international guidelines for good clinical practice and the Declaration of Helsinki and was approved by the institutional review boards at The University of Texas Southwestern Medical Center and the University of Texas, Austin, as well as by each local institutional review board where applicable. Patients provided written informed consent prior to study participation.

The participants in this report were previously described adult outpatients with

Response and remission

In terms of response, the QIDS-C16 and QIDS-SR16 agreed in 88% of patients. The remaining 12% were divided equally between cases in which response was declared based on the QIDS-C16 but not on the QIDS-SR16 and vice versa. In terms of remission, the two scales agreed 94% of the time. The disagreements were also split nearly equally: in 2% of the cases, patients remitted according to the QIDS-C16 but not the QIDS-SR16, while in 4% of cases, the converse was true.

Effect sizes

Table 1 presents effect sizes for

Discussion

This study found that the QIDS-C16 and the QIDS-SR16 are very similar to one another. These results are very similar to those by Rush et al. (2006). The finding of greatest clinical significance is that the two versions are highly comparable. Individual domains relate equally well to overall depression with the two scales. The largest difference involved the relative infrequency with which clinicians used the most extreme category for one item, restlessness/agitation. If anything, the

Acknowledgements

This project was funded in part by the National Institute of Mental Health (NIMH), National Institutes of Health (MH-68851 to the University of Texas Southwestern Medical Center at Dallas, A. John Rush, M.D., PI, and by MH-68852 to the University of Texas at Arlington, Ira H. Bernstein, Ph.D., PI). This research was also supported by NIMH Grant MH-53799, the Robert Wood Johnson Foundation, the Meadows Foundation, the Lightner-Sams Foundation, the Nanny Hogan Boyd Charitable Trust, the Texas

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