Why are there discrepancies between depressed patients’ Global Rating of Change and scores on the Patient Health Questionnaire depression module? A qualitative study of primary care in England

Robinson, J. , Khan, N., Fusco, L., Malpass, A., Lewis, G. and Dowrick, C. (2017) Why are there discrepancies between depressed patients’ Global Rating of Change and scores on the Patient Health Questionnaire depression module? A qualitative study of primary care in England. BMJ Open, 7(4), e014519. (doi: 10.1136/bmjopen-2016-014519) (PMID:28473513) (PMCID:PMC5566896)

Abstract

Objectives: Our aims were to investigate discrepancies between depressed patients’ GlobalRating of Change (GRC) and scores on the Patient Health Questionnaire depression module (PHQ-9). Our objectives were to ascertain patients’ views on the source and meaning of mismatches and assess their clinical significance. Design: Qualitative study nested within a cohort, in a programme investigating the indications for prescribing antidepressants that will lead to a clinical benefit. Setting: Primary care practices in north-west England. Participants: We invited 32 adults with a recent diagnosis of depression and evidence of mismatch between GRC and PHQ-9 Scores to participate. Of these, 29 completed our interviews; most were women, identified as white British, had high school education or higher, were employed or retired and had been depressed for a long time. Main measures: We conducted semistructured interviews with a topic guide, focusing on experiences of depression; treatment experiences and expectations; effectiveness of the questionnaires; reasons for the mismatch; and social factors. Interviews were transcribed and subjected to interpretative phenomenological analysis. Results: We identified four themes as explanations for mismatch between GRC and PHQ-9: perceptions that GRC provided a more accurate assessment of current mental state than PHQ-9; impact of recent negative or positive life events on either measure; personal understanding of depression as normally fluctuating, and tendency to underscore on PHQ-9 as a means of self-motivation; and lack of recall. Conclusions: The combined used of the PHQ-9 and a more open question better captures the patient’s unique experiences of mental health. This approach ascertains the relevance of symptoms to the individual’s experience and influences treatment decisions. Study registration: This study was an element of NIHR Programme Grant RP-PG 0610 10048.

• Item Type: Articles
• Additional Information: This study was funded by the NIHR Programme Grants Scheme, (NIHR Programme Grant – RP PG 0610 10048).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Robinson, Professor Jude
• Authors: Robinson, J., Khan, N., Fusco, L., Malpass, A., Lewis, G., and Dowrick, C.
• College/School: College of Social Sciences
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Published Online: 04 May 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in BMJ Open 7(4): e014519
• Publisher Policy: Reproduced under a Creative Commons License