Why Don't Psychiatrists Use Scales to Measure Outcome When Treating Depressed Patients?
Abstract
OBJECTIVE: A survey of psychiatrists in the United Kingdom found that only a minority routinely used standardized measures to assess outcome when treating depression and anxiety disorders. The goals of the present study were to determine how frequently psychiatrists in the United States use scales to measure outcome when treating depressed patients and, for those clinicians who do not regularly use such scales, to ascertain the reasons for the lack of use. METHOD: The subjects were 314 psychiatrists who attended a continuing medical education conference in California, Massachusetts, New York, or Wisconsin in 2006 or 2007. Prior to a lecture, the subjects completed a questionnaire that included 2 questions regarding the use of rating scales to monitor outcome when treating depression. RESULTS: More than 80% of the psychiatrists indicated that they did not routinely use scales to monitor outcome when treating depression. The most frequent reasons psychiatrists gave for not using scales were that they did not believe scales would be clinically helpful, that scales take too much time to use, and that they were not trained in the use of such measures. CONCLUSIONS: The majority of psychiatrists indicated that they do not routinely use standardized measures to evaluate outcome when treating depressed patients. The Centers for Medicare and Medicaid Services' Physician Quality Reporting Initiative is intended to improve quality of care by providing physicians financial incentives to document outcomes reflecting best practices. If standardized outcome assessment is to assume increasing importance in this country, either educational efforts or payor mandates, or both, will be necessary to change clinicians' behavior.
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These measurement-based care programs do not reach all patients with mental disorders, and most health care providers do not routinely apply measurement-based care.
“However, these programs do not reach all patients with mental disorders, and a majority of health care providers do not routinely apply measurement-based care 48,49 .”
From Measuring and improving the quality of mental health care: a global perspective (2018) · cites this paper as [49]
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BackgroundMFA and ASA-MF: A Psychometric Analysis of Attitudes Towards Measurement-Based Care
Patel, Z. S., Jensen‐Doss, A., & Lewis, C. C. (2021) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-021-01138-2 · Cited by 10 · see citing works
“Less than 12% of psychologists and 20% of psychiatrists in the United States routinely measure mental health symptoms (Hatfield et al., 2010; Zimmerman & McGlinchey, 2008).”
BackgroundMeasurement-Based Care in the Treatment of Anxiety
Romba, C., Lavigne, J. V., Walkup, J. T., & Ballard, R. (2020) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2020.06.004 · Cited by 11 · see citing works
Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition
(2015) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9780890426760.pe02 · Cited by 12 · see citing works
Alves, P., Marci, C. D., Cohen-Stavi, C. J., Whelan, K. M., & Boussios, C. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.01.152 · Cited by 17 · see citing works
McDaniel, B. T., Cornet, V. P., Carroll, J., Chrones, L., Chudzik, J., Cochran, J., Guha, S., Lawrence, D. F. E., McCue, M., Sarkey, S., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05439-8 · Cited by 9 · see citing works
“[50].”
Zimmerman, M. A., Martinez, J. H., Attiullah, N., Friedman, M., Toba, C., Boerescu, D. A., & Rahgeb, M. (2012) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2012.03.001 · Cited by 9 · see citing works
“administration were the 2 most frequently endorsed reasons for not using such instruments [1].”
BackgroundSelf-citationKatzman, M. A., Anand, L., Furtado, M., & Chokka, P. R. (2014) · Psychiatry Research · doi:10.1016/s0165-1781(14)70002-2 · Cited by 9 · see citing works
“reasons cited were lack of faith in their clinical utility, the time involved, and that the physician or his/her staff was not trained in their use (Zimmerman and McGlinchey, 2008).”
BackgroundImproving PHQ9 Utilization Rates in a Primary Care–Mental Health Integration Setting
Brown, M. J., Adams, S. M., Vanderhoef, D. M., Schipani, R., & Taylor, A. (2019) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390319865331 · Cited by 9 · see citing works
“%) regularly utilize MBC for symptom monitoring (Hatfield, McCullough, Frantz, & Krieger, 2010; Zimmerman & McGlinchey, 2008).”
BackgroundDemyttenaere, K., Frank, E., Castle, D. J., & Cindik-Herbrüggen, E. (2019) · Advances in Therapy · doi:10.1007/s12325-019-01038-w · Cited by 9 · see citing works
Building the Thermometer for Mental Health.
Chauvin, J. J., & Insel, T. R. (2018) · Europe PMC (PubMed Central) · Cited by 10 · see citing works
Current Opinions about the Use of Duloxetine: Results from a Survey Aimed at Psychiatrists
Álvarez-Mon, M., García-Montero, C., Fraile-Martínez, Ó., Quintero, J., Fernandez-Rojo, S., Mora, F., Gutiérrez-Rojas, L., Molina-Ruiz, R., Lahera, G., Álvarez-Mon, M., et al. (2023) · Brain Science · doi:10.3390/brainsci13020333 · Cited by 9 · see citing works
“In this sense, considering the experience and professional opinion shared by clinicians is essential to verify the use and applications of different antidepressant alternatives in the field of MDD [17,18].”
BackgroundLi, V. W., Sahota, J., Dev, D. K., Gill, D. D., Evans, V. C., Axler, A., Chakrabarty, T., Do, A., Keramatian, K., Nunez, J.-J., et al. (2024) · The Canadian Journal of Psychiatry · doi:10.1177/07067437241245331 · Cited by 8 · see citing works
A clinical predictive score for mood disorder risk in low-income primary care settings
Vöhringer, P. A., Jimenez, M. I., Igor, M., Fores, G. A., Correa, M. O., Sullivan, M. C., Holtzman, N. S., Whitham, E. A., Barroilhet, S. A., Alvear, K., et al. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.06.056 · Cited by 8 · see citing works
Measurement of Common Mental Health Conditions in VHA Co-located, Collaborative Care
Beehler, G. P., King, P. R., Vair, C. L., Gass, J. C., & Funderburk, J. S. (2016) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-016-9478-3 · Cited by 8 · see citing works
“Finally, we compared likelihood of measurement in relation to provider credentials as training in the use of measurement tools may vary by professional preparation (Gilbody, House, & Sheldon, 2002; Zimmerman & McGlinchey, 2008).”
MethodPages, K. P., Aaronson, S. T., Carpenter, L. L., Hutton, T. M., Rush, A. J., & Sackeïm, H. A. (2024) · Transcranial magnetic stimulation . · doi:10.1016/j.transm.2024.100075 · Cited by 7 · see citing works
Implementing Measurement-Based Care in Various Practice Settings
Krishna, R., Jeffrey, J. K., & Patel, P. D. (2020) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2020.06.007 · Cited by 7 · see citing works
Chokshi, S. K., Senathirajah, Y., Yadav, V., Winsberg, M., O’Callaghan, E., Sullivan, S., Verma, A., & Kachnowski, S. (2022) · Cureus · doi:10.7759/cureus.21219 · Cited by 6 · see citing works
“Despite the clearly proven benefits of measurement-based care, less than 20% of psychiatrists use it in their practice, emphasizing the need for better solutions to facilitate more widespread adoption of measurementbased care [17].”
BackgroundKrause, K. R., Chung, S., Rodak, T., Cleverley, K., Butcher, N. J., & Szatmári, P. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-054679 · Cited by 5 · see citing works
Ridout, K. K., Vanderlip, E. R., Carlo, A. D., Kadriu, B., Livesey, C., Torous, J. B., & Alter, C. L. (2025) · Psychiatric Services · doi:10.1176/appi.ps.20240372 · Cited by 5 · see citing works
Mineo, L., Rodolico, A., Concerto, C., Natale, A., Pennisi, M., Tusconi, M., Aguglia, A., Amerio, A., Serafini, G., Amore, M., et al. (2021) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/1745017902117010331 · Cited by 6 · see citing works
“The participants could choose from the following assessment tools: Affective Self Rating Scale [30], Bech-Rafaelsen Mania Scale [31], ClinicianAdministered Rating Scale for Mania [32], Hypomania Checklist (HCL32) [33], Hypomania Interview Guide [34], Internal State Scale [35], Koukopoulos Mixed Depression Rating Scale…”
BackgroundMethodInfluentialKing, P. R., Beehler, G. P., Wade, M. J., Buchholz, L. J., Funderburk, J. S., Lilienthal, K. R., & Vair, C. L. (2018) · Families Systems & Health · doi:10.1037/fsh0000379 · Cited by 5 · see citing works
Early Improvement Predicts Treatment Outcomes for Patients With Acute Mania
Li, D., Lin, C., & Lu, M.-J. (2017) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000728 · Cited by 5 · see citing works
“Standardized scales have seldom been used in routine clinical practice.(38) Certain limitations of this study must also be mentioned.”
MethodAssistive Technologies for Bipolar Disorder: A Survey
Anwar, Y., & Arshia (2019) · International Journal of Advanced Computer Science and Applications · doi:10.14569/ijacsa.2019.0100461 · Cited by 5 · see citing works
“However, according to a national survey in United Kingdom in 2002 [52], a study in 2006 [53] and another one in Korea in 2010 [18], it appears that more than half of the psychiatrists do not prefer using any scale of measure to assess the patients and their diagnosis is entirely based upon their understanding of what…”
Zimmerman, M. A., Balling, C. E., Chelminski, I., & Dalrymple, K. L. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.05.073 · Cited by 5 · see citing works
Self-citationEducating Mental Health Trainees About Measurement-Based Care: A Scoping Review
Freedman, D., Waddell, A., Bourdon, A., Lam, H., & Wang, K. (2023) · Academic Psychiatry · doi:10.1007/s40596-023-01749-x · Cited by 5 · see citing works
“9% of psychiatrists in the USA and routinely used by just 5% of mental health clinicians in the UK [15, 16].”
Background
- Authors
- Zimmerman, M., & McGlinchey, J. B.
- Affiliations
- Brown University (US)
- ORCID
- Zimmerman, Mark
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2008-12-31
- Volume
- 69
- Issue
- 12
- Pages
- 1916-1919
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2092574656
- Cited by
- 179
- References
- 0
- Citations by year
- 2026: 7 · 2025: 17 · 2024: 13 · 2023: 10 · 2022: 10 · 2021: 14 · 2020: 11 · 2019: 12 · 2018: 20 · 2017: 9 · 2016: 7 · 2015: 4 · 2014: 5 · 2013: 6 · 2012: 7
- FWCI
- 12.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- depression, outcome measurement, rating scales, psychiatrists, clinician behavior, Physician Quality Reporting Initiative, quality of care, continuing medical education, anxiety disorders
- MeSH terms
- Adult, Aged, Antidepressive Agents, Attitude of Health Personnel, Depressive Disorder, Education, Medical, Continuing, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychiatry, Quality Assurance, Health Care, Surveys and Questionnaires, Outcome Assessment, Health Care
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