Psychiatrists in the United Kingdom and The United States of America and probably also in The Netherlands hardly use scales to measure outcome when treating depressed patient. In mental health clinic or outpatient units the evaluation is typically based on unstructured interactions leading to unquantified judgment of progress. Imagine a primary physician or internist not measuring temperature, white blood cell count etc when someone has pneumonia. Or a GP not measuring blood pressure after a patient has started with anti hypertensive medication. In mental health care standardized, quantifiable outcome measures exist but hardly used.
You don’t have to do a weekly severity scale such as the Hamilton Depression Rating scale as in research but at least use it when starting an antidepressant and when deciding on outcome before you switch or augment. One of the few good results of STAR*D was the advocacy of the importance of using scales to measure outcome: “measurement based care”.
In the UK 11.2% of 340 psychiatrists routinely used outcome measures when treating depression and anxiety disorders. In the US less than 10% almost always used scales to monitor outcome, more than half of the 314 psychiatrists indicated that they never or rarely used scales to monitor outcome.
- They believed that using scales would not be clinically helpful
- That the scales would take too much time to use
- That they were not trained in their use
- They preferred to assess outcome “clinically”
The groups of those using scales routinely and those not using scales were comparable on all characteristics, no differences in gender, age, years of practice, or practice setting.
Most of the reasons for not using scales to measure outcome for depressed patients are probably based on the use of the Hamilton Rating Scale for Depression or the Montgomery-Asberg Rating Scale rather than thinking of self-report scales such as the Beck Depression Inventory or the Zung Depression Ratings scale. These hardly cost time or training. They are valid and reliable measures of severity of depression.
In our residency program we start our training with an Introduction week. In this week they receive education on important topics to start doing their work especially for their work when on call. The training with the Hamilton Depression Rating Scale for Depression is the least valued part of the whole week.
Do you use outcome measures when treating depressed patients and do you educate your residents and train them for using these rating scales, let me know in the comments.
Zimmerman, Mark, & McGlincey, Joseph B. (2008). Why Don’t Psychiatrists Use Scales to Measure Outcome When Treating Depressed Patients? Journal of Clinical Psychiatry, 69, 1916-1919 DOI: 19192467