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Inter-rater reliability among psychiatrists when assessing depression according to the Montgomery-Åsberg Depression
Jonas Geijer1, Amir Baigi2, Harald Aiff3
1Psychiatric Department of Halland, Region Halland, Psykiatrin i Halland HSH, Halmstad, Sweden.
Introduction:
Montgomery-Åsberg Depression Rating Scale (MADRS) is a validated tool for rating the depth of depression. The structured interview guide for the MADRS (SIGMA) is an interview guide that has been developed in order to increase the inter-rater reliability. Patients often meet more than one psychiatrists during their hospitalization for depression. A divergent rating of depression between psychiatrists could affect both the treatment and the outcome. This makes knowledge of the inter-rater reliability among psychiatrists important.
Aim:
The primary aim of this study was to measure the inter-rater reliability between psychiatrists when rating depression using the MADRS.
Methods:
Ten in-patients, who were diagnosed with depression, were filmed while being interviewed using the SIGMA. The patients were after that instructed to rate themselves using the self-rating version of the MADRS. Ten psychiatrists rated the pre-recorded interviews according to the MADRS. The inter-rater reliability was measured using intra-class correlation (ICC).
Results:
The mean ICC for the total MADRS score was 0.952 (95% CI 0.891-0.986; p<.001) and Cronbach's alpha 0.961. ICC values for each item ranged between 0.866 and 0.978 (p<.001). Cronbach's alpha ranged between 0.905 and 0.984. The ICC values, when comparing the psychiatrists rating to the patients rating, ranged between 0.307 and 0.809 (p<.001).
Conclusion:
All of the ICC values in the study, except when comparing the psychiatrists rating to the patients self-rating, were considered to be excellent. This study confirms the findings of reliability found in similar studies which involved fewer raters and not exclusively psychiatrists.
Insights
Psychiatrists show excellent inter-rater reliability when using the Montgomery-Åsberg Depression Rating Scale (MADRS) with the SIGMA interview guide. This ensures consistent depression severity ratings for better patient treatment and outcomes.
Area of Science:
- Psychiatry
- Clinical Psychology
Background:
- The Montgomery-Åsberg Depression Rating Scale (MADRS) is a standard for assessing depression severity.
- Ensuring consistent MADRS ratings among psychiatrists is crucial for effective treatment and patient outcomes.
- The Structured Interview Guide for the MADRS (SIGMA) aims to improve inter-rater reliability.
Purpose of the Study:
- To evaluate the inter-rater reliability of psychiatrists using the MADRS with the SIGMA interview guide.
- To assess the consistency of depression severity ratings between multiple psychiatrists.
Main Methods:
- Ten patients diagnosed with depression were interviewed using the SIGMA and filmed.
- Ten psychiatrists independently rated the filmed interviews using the MADRS.
- Inter-rater reliability was quantified using intra-class correlation (ICC) coefficients.
Main Results:
- Excellent inter-rater reliability was observed among psychiatrists for the total MADRS score (ICC=0.952) and individual items (ICC range: 0.866-0.978).
- Cronbach's alpha values also indicated high internal consistency for the MADRS ratings.
- Lower agreement was found between psychiatrist ratings and patient self-ratings (ICC range: 0.307-0.809).
Conclusions:
- Psychiatrists demonstrate excellent inter-rater reliability when utilizing the MADRS with the SIGMA.
- These findings support the use of SIGMA to enhance consistent depression assessment in clinical practice.
- The study highlights the importance of standardized tools for reliable psychiatric evaluations.
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