How well do clinicians and patients agree on depression treatment outcomes? Implications for personalized medicine.

OBJECTIVE: In order to inform outcomes assessments in personalized medicine research, we evaluated the level of agreement between self-reported (SR) and clinician-rated (CR) measures of depression severity before and after treatment with an antidepressant medication. METHODS: We pooled data from three trials (totaling 2075 patients) assessing the efficacy of antidepressant monotherapy in major depressive disorder. Differences between CR (17-item Hamilton Rating Scale for Depression [HAM-D17]) and SR (30-item Inventory of Depressive Symptomatology-Self-Rated) scale scores were used to determine concordance between CR-SR ratings. The effect of anxiety (HAMD17 anxiety-somatization subscale score ≥7) on SR-CR agreement was also assessed. RESULTS: The CR-SR scale agreement was good for response (κ = 0.64) and moderate for remission (κ = 0.57). Patients who rated their depression as less severe than the clinician were significantly more likely to respond to treatment than over-reporters (odds ratio = 1.62; 95% confidence interval: 1.17-2.25). Although anxiety did not impact the level of agreement, among patients with SR-CR discordance, high anxiety was associated with over-reporting of depression severity. CONCLUSION: The levels of disagreement for response and remission were too high for CR and SR scales to be considered interchangeable for research on patient-level outcomes. Anxiety does not meaningfully impact SR-CR agreement.

Assessment of parents' smoking behaviors at a pediatric emergency department.

The pediatric emergency department is an important source of treatment for children with complaints related to environmental tobacco smoke (ETS) and may provide a teachable moment to address parent smoking. Parents who smoke were recruited from a pediatric emergency department waiting room and completed an interview assessment used to develop intervention messages. Of the 715 parents in the final sample, 77% were women, 60% White, and 60% low income (