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Why are there discrepancies between depressed patients’ Global Rating of Change and scores on the Patient Health Questionnaire depression module? A qualitative study of primary care in England
  1. Jude Robinson1,
  2. Naila Khan2,
  3. Louise Fusco2,
  4. Alice Malpass3,
  5. Glyn Lewis4,
  6. Christopher Dowrick2
  1. 1 Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, UK
  2. 2 Department of Psychological Sciences, University of Liverpool, Liverpool, UK
  3. 3 School of Social and Community Based Medicine, University of Bristol, Bristol, UK
  4. 4 Department of Mental Health Sciences Unit, UCL Psychiatric Epidemiology, London, UK
  1. Correspondence to Prof Christopher Dowrick; cfd{at}


Objectives Our aims were to investigate discrepancies between depressed patients’ GlobalRating of Change (GRC) and scores on the Patient Health Questionnaire depression module (PHQ-9). Our objectives were to ascertain patients’ views on the source and meaning of mismatches and assess their clinical significance.

Design Qualitative study nested within a cohort, in a programme investigating the indications for prescribing antidepressants that will lead to a clinical benefit.

Setting Primary care practices in north-west England.

Participants We invited 32 adults with a recent diagnosis of depression and evidence of mismatch between GRC and PHQ-9 Scores to participate. Of these, 29 completed our interviews; most were women, identified as white British, had high school education or higher, were employed or retired and had been depressed for a long time.

Main measures We conducted semistructured interviews with a topic guide, focusing on experiences of depression; treatment experiences and expectations; effectiveness of the questionnaires; reasons for the mismatch; and social factors. Interviews were transcribed and subjected to interpretative phenomenological analysis.

Results We identified four themes as explanations for mismatch between GRC and PHQ-9: perceptions that GRC provided a more accurate assessment of current mental state than PHQ-9; impact of recent negative or positive life events on either measure; personal understanding of depression as normally fluctuating, and tendency to underscore on PHQ-9 as a means of self-motivation; and lack of recall.

Conclusions The combined used of the PHQ-9 and a more open question better captures the patient’s unique experiences of mental health. This approach ascertains the relevance of symptoms to the individual’s experience and influences treatment decisions.

Study registration This study was an element of NIHR Programme Grant RP-PG 0610 10048.

  • depression
  • diagnosis
  • patient perspectives
  • mismatch
  • PHQ-9

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributor JR and AM conceived and designed the study with CD and GL. LF and NK conducted the interviews and qualitative analysis, and drafted the manuscript. JR, CD, GL and AM critically revised the manuscript. All authors approved the final manuscript; I, CD, affirm that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted.

  • Funding This study was funded by the NIHR Programme Grants Scheme, (NIHR Programme Grant – RP PG 0610 10048). However the researchers remain independent from the funders and the funders did not play a role in the study design or data collection for the study.

  • Competing interests None declared.

  • Patient consent Not obtained.

  • Ethics approval This study was granted ethical approval by Bristol Research Ethics Committee Centre (12/SW/0267).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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