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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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“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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“CONCLUSIONS AND RELEVANCE This narrative review, informed by implementation science, offers a 10-point research agenda to improve the integration of MBC into clinical practice: (1) harmonize terminology and specify MBC’s core components; (2) develop criterion standard methods for monitoring fidelity and reporting qual…”
A Tipping Point for Measurement-Based Care
Fortney, J. C., Unützer, J., Wrenn, G. L., Pyne, J. M., Smith, G. R., Schoenbaum, M., & Harbin, H. T. (2016) · Psychiatric Services · doi:10.1176/appi.ps.201500439 · Cited by 592
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“Surveys spanning different countries indicate that few clinicians actually employ ROM in their dayto-day work (Gilbody, House, & Sheldon, 2002; Hatfield & Ogles, 2004; Zimmerman & McGlinchey, 2008).”
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“Therefore, monitoring and treatment of anxiety symptoms could enhance clinical practice by optimizing antidepressant treatment (Zimmerman and McGlinchey, 2008).”
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“Despite its clinical benefits, it is estimated that less than 1 in 5 psychiatrists and less than 1 in 9 psychologists routinely use MBC (Hat-field et al., 2010; Zimmerman & McGlinchey, 2008).”
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“Moreover, care is not measurement-based, follow-up is infrequent and ad hoc, and there is no proactive outreach [28,39].”
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“However, only few clinicians use ROM data in their day-to-day work [13, 14].”
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“This is likely partly due to the fact that many psychological assessments are rather lengthy, and may involve complicated scoring algorithms (in contrast to the general swiftness and ease of the aforementioned blood pressure assessments; Zimmerman & McGlinchey, 2008).”
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Dalrymple, K. L., Martinez, J. H., Tepe, E., Young, D., Chelminski, I., Morgan, T. A., & Zimmerman, M. A. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.02.006 · Cited by 22
“Surveys of psychiatrists in clinical practice in the United Kingdom and United States have found that the majority do not use symptom rating scales of depression or anxiety to monitor progress throughout treatment [1, 2].”
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“Observer-rating scales benefit from the experience of the rater, supposed to be free from patient bias [12,14], while selfrating scales are less time-consuming and supposed to be free from clinician bias [8,14].”
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“Nonetheless, only 10–20% of community behavioral health therapists use MBC (Hatfield & Ogles, 2007; Jensen-Doss et al., 2018; Zimmerman & McGlinchey, 2008) and efforts to implement this practice are often unsuccessful (Bickman et al., 2016; Garland et al., 2003).”
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“Thus, the monitoring and treatment of anxiety symptoms can enhance clinical practice by optimizing antidepressant therapy and overall clinical outcome (Zimmerman and McGlinchey, 2008).”
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Self-citationHigh-Yield Cognitive-Behavior Therapy for Brief Sessions
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“As previous studies have shown that clinicians do not always use ROM outcome in their day-to-day work [15, 16] and various problems in patients with a psychotic disorder remain undetected or untreated [13], we expect a discrepancy between problems identified with ROM and the problems that are reflected in the treatmen…”
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“However, several studies have indicated that few clinicians in psychiatry use the outcome of ROM in their day-to-day work [13,14].”
BackgroundHarnessing Technology to Implement Measurement-Based Care
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“Despite this, less than 20% of psychiatrists consistently use MBC in their treatments [12], a statistic uncovering a significant lag in translating MBC research into clinical practice.”
BackgroundChronic wound-associated pain, psychological stress, and wound healing.
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“…to conducting MBC identified in previous works likely extend to CCC (e.g., time constraints, provider acceptability; Gilbody, House, & Sheldon, 2002; Zimmerman & McGlinchey, 2008), a more thorough investigation of potentially unique facilitators and barriers to MBC in integrated care is called for.”
BackgroundZhang, W.-Y., Zhao, Y.-J., Zhang, Y., He, F., Pan, H.-Q., Cheung, T. C. C., Ungvari, G. S., Li, S.-Y., & Xiang, Y. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.598609 · Cited by 13
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“Despite this, according to a survey conducted in the UK involving 314 psychiatrists, over 80 % of the clinicians do not routinely employ rating scales for outcome monitoring in the treatment of depression (Zimmerman and McGlinchey, 2008).”
BackgroundImplementing Outcome-based Care in Pediatric Psychiatry: Early Results and Overcoming Barriers
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“2,3,10,11 Despite the potential benefits, psychiatrists do not regularly use these techniques due to both perceived and Pediatric Quality and Safety actual barriers such as a preference for their clinical assessment, uncertainty as to the added value of standardized measures, and barriers to the…”
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
“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
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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
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
“[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
“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
“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
“%) 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
Building the Thermometer for Mental Health.
Chauvin, J. J., & Insel, T. R. (2018) · Europe PMC (PubMed Central) · Cited by 10
Current Opinions about the Use of Duloxetine: Results from a Survey Aimed at Psychiatrists
Álvarez-Mon, M. Á., Montero, C. G., Fraile‐Μartinez, O., Quintero, J., Fernández-Rojo, S., Mora, F., Gutiérrez-Rojas, L., Molina-Ruiz, R. M., Lahera, G., Álvarez-Mon, M., et al. (2023) · Brain Sciences · doi:10.3390/brainsci13020333 · Cited by 8
“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
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 9
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
“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
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
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
“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
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
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 7
“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
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
“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
“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
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
“9% of psychiatrists in the USA and routinely used by just 5% of mental health clinicians in the UK [15, 16].”
Background
Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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