Selecting Measurements Whats Available

At intake, differential diagnosis of MDD is necessary to identify appropriate alternative acute-phase treatment options, and throughout A-CT, symptom assessment is key in structuring therapy sessions, gauging acute-phase treat-

ment response, and identifying which patients need C-CT. Instruments that clinicians may use to measure the syndrome and severity of depressive symptoms are described below.

To assess the syndrome of depression, to rule out other disorders, and to diagnose concurrent psychiatric disorders, the Structured Clinical Interview for DSM (SCID; First, Spitzer, Gibbon, & Williams, 1996; Spitzer, Williams, Gibbon, & First, 1992) is a benchmark instrument. With appropriately trained clinicians, SCID diagnoses for MDD have demonstrated strong psychometric properties (Zanarini et al., 2000; Miller, Dasher, Collins, Griffiths, & Brown, 2001), although administering the full interview can be relatively time-consuming (typically 1-2 hours).

Clinicians who do not have the time to use the SCID may use screening measures such as the Primary Care Evaluation of Mental Disorders (PRIME-MD; Spitzer et al., 1994) or its patient-report version, the Patient Health Questionnaire (PHQ; Spitzer, Kroenke, & Williams, 1999), also available as a short form (PHQ-9; Kroenke, Spitzer, & Williams, 2001). The self-report measures have shown adequate agreement with interview-based diagnoses, and sufficient validity to be used to track progress during treatment (Kroenke & Spitzer, 2002). Because differentiating patients with bipolar disorders who require pharmacotherapy is especially important, we recommend that clinicians include a screen for a history of mania, such as the Mood Disorder Questionnaire (MDQ; Hirschfeld et al., 2000), a brief patient-report measure.

After making a primary diagnosis of MDD and beginning A-CT, clinicians need to assess depressive symptom severity frequently to structure therapy sessions, to gauge patients' progress over time, to identify treatment response, and to make an informed and collaborative decision about continuing or discontinuing treatment. Depressive symptoms may be assessed equally well with both self- and clinician reports (Vittengl, Clark, Kraft, & Jarrett, 2005), so time-pressured clinicians may prefer to use shorter patient reports. Measures of depressive symptom severity with acceptable psychometric properties include the Hamilton Rating Scale for Depression (HRSD; Hamilton, 1960), the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) or the BDI-II (Beck, Steer, & Brown, 1996), and the Inventory for Depressive Symptomatology (IDS; Rush et al., 1986; Rush, Gullion, Basco, Jarrett, & Trivedi, 1996; Trivedi, Rush, Ibrahim, Carmody, Biggs, et al., 2004), which is available in parallel Self-Report (IDS-SR) and Clinician (IDS-C) versions.

Vittengl et al. (2005) found that total scores on these four measures demonstrated high convergence in their pattern and degree of change during A-CT. Moreover, the 16-item Quick IDS (Q-IDS; Rush et al., 2003), available in both Self-Report (Q-IDS-SR) and Clinician (Q-IDS-C) versions, correlates highly (r's = .94) with these measures. Using conversions of scores among the four measures (derived from their common factor; Vittengl et al., 2005;Jarrett, Vittengl, & Clark, 2005), clinicians can compare their patients' progress during CT to the modal or mean progress ofpatients treated in research studies. When CT fails to produce typical results, clinicians should consider an alternative approach (e.g., pharmacotherapy as an alternative or adjunct).

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