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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; 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) , Article e014519. 10.1136/bmjopen-2016-014519. Green open access

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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.

Type: Article
Title: 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
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjopen-2016-014519
Publisher version: http://dx.doi.org/10.1136/bmjopen-2016-014519
Language: English
Additional information: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/ © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Keywords: PHQ-9, PRIMARY CARE, depression, diagnosis, mismatch, patient perspectives
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/1557287
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