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Person-fit feedback on inconsistent symptom reports in clinical depression care

Published online by Cambridge University Press:  27 November 2017

Rob B. K. Wanders ,
Rob R. Meijer ,
Henricus G. Ruhé ,
Sjoerd Sytema ,
Klaas J. Wardenaar  and
Peter de Jonge
Rob B. K. Wanders*
Affiliation:
Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Rob R. Meijer
Affiliation:
Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
Henricus G. Ruhé
Affiliation:
Department of Psychiatry, Mood and Anxiety Disorders, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Sjoerd Sytema
Affiliation:
Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Klaas J. Wardenaar
Affiliation:
Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Peter de Jonge
Affiliation:
Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
*
Author for correspondence: Rob B. K. Wanders, E-mail: [email protected]
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Abstract

Background

Depressive patients can present with complex and different symptom patterns in clinical care. Of these, some may report patterns that are inconsistent with typical patterns of depressive symptoms. This study aimed to evaluate the validity of person-fit statistics to identify inconsistent symptom reports and to assess the clinical usefulness of providing clinicians with person-fit score feedback during depression assessment.

Methods

Inconsistent symptom reports on the Inventory of Depressive Symptomatology Self-Report (IDS-SR) were investigated quantitatively with person-fit statistics for both intake and follow-up measurements in the Groningen University Center of Psychiatry (n = 2036). Subsequently, to investigate the causes and clinical usefulness of on-the-fly person-fit alerts, qualitative follow-up assessments were conducted with three psychiatrists about 20 of their patients that were randomly selected.

Results

Inconsistent symptom reports at intake (12.3%) were predominantly characterized by reporting of severe symptoms (e.g. psychomotor slowing) without mild symptoms (e.g. irritability). Person-fit scores at intake and follow-up were positively correlated (r = 0.45). Qualitative interviews with psychiatrists resulted in an explanation for the inconsistent response behavior (e.g. complex comorbidity, somatic complaints, and neurological abnormalities) for 19 of 20 patients. Psychiatrists indicated that if provided directly after the assessment, a person-fit alert would have led to new insights in 60%, and be reason for discussion with the patient in 75% of the cases.

Conclusions

Providing clinicians with automated feedback when inconsistent symptom reports occur is informative and can be used to support clinical decision-making.

Keywords

Decision support techniquesdepressioninconsistent symptom reportsperson fitself-report
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 11 , August 2018 , pp. 1844 - 1852
Copyright
Copyright © Cambridge University Press 2017 

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