PMID- 33138872
OWN - NLM
STAT- MEDLINE
DCOM- 20221124
LR  - 20221218
IS  - 1469-8978 (Electronic)
IS  - 0033-2917 (Print)
IS  - 0033-2917 (Linking)
VI  - 52
IP  - 10
DP  - 2022 Jul
TI  - How much change is enough? Evidence from a longitudinal study on depression in UK 
      primary care.
PG  - 1875-1882
LID - 10.1017/S0033291720003700 [doi]
AB  - BACKGROUND: The Patient Health Questionnaire (PHQ-9), the Beck Depression 
      Inventory (BDI-II) and the Generalised Anxiety Disorder Assessment (GAD-7) are 
      widely used in the evaluation of interventions for depression and anxiety. The 
      smallest reduction in depressive symptoms that matter to patients is known as the 
      Minimum Clinically Important Difference (MCID). Little empirical study of the 
      MCID for these scales exists. METHODS: A prospective cohort of 400 patients in UK 
      primary care were interviewed on four occasions, 2 weeks apart. At each time 
      point, participants completed all three questionnaires and a 'global rating of 
      change' scale (GRS). MCID estimation relied on estimated changes in symptoms 
      according to reported improvement on the GRS scale, stratified by baseline 
      severity on the Clinical Interview Schedule (CIS-R). RESULTS: For moderate 
      baseline severity, those who reported improvement on the GRS had a reduction of 
      21% (95% confidence interval (CI) -26.7 to -14.9) on the PHQ-9; 23% (95% CI -27.8 
      to -18.0) on the BDI-II and 26.8% (95% CI -33.5 to -20.1) on the GAD-7. The 
      corresponding threshold scores below which participants were more likely to 
      report improvement were -1.7, -3.5 and -1.5 points on the PHQ-9, BDI-II and 
      GAD-7, respectively. Patients with milder symptoms require much larger reductions 
      as percentage of their baseline to endorse improvement. CONCLUSIONS: An MCID 
      representing 20% reduction of scores in these scales, is a useful guide for 
      patients with moderately severe symptoms. If treatment had the same effect on 
      patients irrespective of baseline severity, those with low symptoms are unlikely 
      to notice a benefit. FUNDING: Funding. National Institute for Health Research.
FAU - Kounali, Daphne
AU  - Kounali D
AUID- ORCID: 0000-0002-6392-6690
AD  - Bristol Medical School, University of Bristol, Bristol, UK.
FAU - Button, Katherine S
AU  - Button KS
AUID- ORCID: 0000-0003-4332-8789
AD  - Department of Psychology, University of Bath, UK.
FAU - Lewis, Gemma
AU  - Lewis G
AD  - Division of Psychiatry, University College London, London, UK.
FAU - Gilbody, Simon
AU  - Gilbody S
AD  - Department of Health Sciences, University of York, York, UK.
FAU - Kessler, David
AU  - Kessler D
AD  - Bristol Medical School, University of Bristol, Bristol, UK.
FAU - Araya, Ricardo
AU  - Araya R
AD  - Institute of Psychiatry, Psychology and Neuroscience, King's College London, 
      London, UK.
FAU - Duffy, Larisa
AU  - Duffy L
AD  - Division of Psychiatry, University College London, London, UK.
FAU - Lanham, Paul
AU  - Lanham P
AD  - Bristol Medical School, University of Bristol, Bristol, UK.
FAU - Peters, Tim J
AU  - Peters TJ
AD  - Bristol Medical School, University of Bristol, Bristol, UK.
FAU - Wiles, Nicola
AU  - Wiles N
AD  - Bristol Medical School, University of Bristol, Bristol, UK.
FAU - Lewis, Glyn
AU  - Lewis G
AD  - Division of Psychiatry, University College London, London, UK.
LA  - eng
GR  - RP-PG-0610-10048/Department of Health/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20201103
PL  - England
TA  - Psychol Med
JT  - Psychological medicine
JID - 1254142
SB  - IM
MH  - Humans
MH  - *Depression/epidemiology/therapy/diagnosis
MH  - Longitudinal Studies
MH  - Prospective Studies
MH  - *Primary Health Care
MH  - United Kingdom
PMC - PMC9340848
OTO - NOTNLM
OT  - BDI-II
OT  - Baseline severity depression
OT  - GAD-7
OT  - PHQ-9
OT  - beta-regression
OT  - depression
OT  - minimal clinically important difference
OT  - primary care
COIS- None
EDAT- 2020/11/04 06:00
MHDA- 2022/11/25 06:00
PMCR- 2022/08/01
CRDT- 2020/11/03 05:33
PHST- 2020/11/04 06:00 [pubmed]
PHST- 2022/11/25 06:00 [medline]
PHST- 2020/11/03 05:33 [entrez]
PHST- 2022/08/01 00:00 [pmc-release]
AID - S0033291720003700 [pii]
AID - 10.1017/S0033291720003700 [doi]
PST - ppublish
SO  - Psychol Med. 2022 Jul;52(10):1875-1882. doi: 10.1017/S0033291720003700. Epub 2020 
      Nov 3.