Comparison of physician-rating and self-rating scales for patients with major depressive disorder.

Physician-rating scales remain the standard in antidepressant clinical trials. The current study aimed to examine the discrepancies between physician-rating scales and self-rating scales for symptoms and functioning, before and after treatment, in newly hospitalized patients. A total of 131 acutely ill inpatients with major depressive disorder were enrolled to receive 20 mg of fluoxetine daily for 6 weeks. Symptom severity and functioning were assessed at baseline and again at week 6. Symptom severity was rated using the 17-item Hamilton Depression Rating Scale (HDRS-17) and the Zung Self-rating Depression Scale (ZDS). Functioning was measured by the Global Assessment of Functioning (GAF) and the Work and Social Adjustment Scale (WSAS). Pearson correlation coefficients (r) between HDRS-17 and ZDS and between GAF and WSAS were calculated at week 0 and week 6. Sensitivity to change was measured using effect sizes. One-hundred twelve patients completed the 6-week trial. After 6 weeks of treatment, correlations between HDRS-17 and ZDS or correlations between GAF and WSAS became larger from baseline to end point. All correlations were statistically significant (P < 0.001). Effect sizes measured by physician-rating scales (ie, HDRS-17 and GAF) were larger than by self-rating scales (ie, ZDS and WSAS). Correlations between baseline physician-rating scale scores and self-rating scale scores improved after 6 weeks of treatment. Physician-rating scales had larger effect sizes than self-rating scales. Physician-rating scales were more sensitive in detecting symptom or functional changes than self-rating scales.