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One size fits all?

Family Physician, Sooke, BC

The article by McIntyre and colleagues¹ rightly points out the importance of measurement of severity of depression and remission of symptoms in mental health and primary care settings. After attending the CANMAT conference in Vancouver in June 2005, I wonder about the issue of inter-rater variability. Approximately 30 psychiatrists and family physicians were instructed in the scoring of the HAMD-7, observed the same simulated interview, and then scored the severity of the depression of the simulated patient using the HAMD-7. The range of scores was 5 points from lowest to highest score. This underlined the subjectivity and variability of many of the scoring decisions made by clinicians.

There are other scales that perform as well or better in the primary care setting. Expecting a single tool to fit primary care and tertiary mental health settings may limit its uptake in both settings. Perhaps we should not be taking a 'one-size-fits-all' approach.

I am also concerned about the time it takes to complete the HAMD-7. I have found it more efficient to use a patient-rated scale specifically designed for primary care (the PHQ-9). The PHQ-9 scores severity, remission and response, and includes a quality of life question and a suicide screener question.^2–5 I then follow up with patients who score over 5, have a positive response to the suicide question, or whose experience has a large impact on their quality of life. This strategy is an efficient and effective use of my limited time.

REFERENCE

1. McIntyre RS, Konarski JZ, Mancini DA, et al. Measuring the severity of depression and remission in primary care: validation of the HAMD-7 Scale [published erratum in CMAJ 2006;174(2):207]. CMAJ 2005;173(11):1327-34.[Free Full Text]
2. Nezu AM, Ronan GF, Meadows EA, et al. A practitioner's guide to empirically based measures of depression. New York: Kluwer Academic/Plenum Publishers; 2000.
3. Spitzer RL, Williams JB, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994;272:1749-56.[Abstract/Free Full Text]
4. Brody DS, Hahn SR, Spitzer RL, et al. Identifying patients with depression in the primary care setting: a more efficient method. Arch Intern Med 1998;158:2469-75.[Abstract/Free Full Text]
5. Nease DE Jr, Maloin JM. Depression screening: a practical strategy. J Fam Pract 2003;52(2):118-24.[Medline]

This Article Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Anderson, J. E. Search for Related Content PubMed PubMed Citation Articles by Anderson, J. E. Related Collections Mood disorders (including depression)

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