The neglect of response bias in mental health research.

A number of researchers have observed that response biases, defined as when subjects respond to items in research instruments in ways that do not coincide with the intent or content of the instrument, suffuse measurements and assessments of mental disorders. They cautioned that the response bias problem has been neglected in mental health research at the price of substantial error. Have the cautions been heeded? Or does the neglect of response bias continue? Articles published in 1998 in three major psychiatric journals were examined: Archives of General Psychiatry, American Journal of Psychiatry, and the Journal of Nervous and Mental Disease. The articles were examined to determine whether response biases were mentioned and whether systematic efforts were made to attend to their influence on the findings of the study. Each article was assessed twice by independent raters. The examination indicates that a very small minority of the articles reviewed mentioned response bias and that among those mentioning it, a minority attempted to control for bias effects. Cautions offered about response bias have not been heeded. Accordingly, the issue is one of how to incorporate concerns about response bias into the institutional structures that influence the culture of mental health research.