Aversion to Mental and Behavioral Health Metrics
Gilbody surveyed 340 psychiatrists in the United Kingdom. They found that only 11.2% of psychiatrists routinely used standardized measures to assess outcomes when treating depression and anxiety disorders. Zimmerman and McGlinchey surveyed 314 psychiatrists in the US. They too found that the vast majority of psychiatrists did not routinely use clinical scales to monitor depression treatment outcomes.
Gilbody did not ask the respondents why they were disinclined to use scales to measure outcomes. Fortunately, several respondents included comments on the surveys indicating such scales were simplistic, not useful in clinical practice, of questionable reliability and validity, overly burdensome, or too costly.
Zimmerman and McGlinchy did ask psychiatrists reporting that they never, rarely, or only sometimes were using scales to monitor outcomes in their clinical practice why they weren’t doing so routinely. More than one-quarter of them indicated that they did not believe using scales would be clinically helpful, that they take too much time to use, or that they were not trained in their use.
One issue identified as an obstacle in their use is the perceived burden of scale completion. If the payers of the delivery of mental health treatment increasingly encourage, or require, the measurement of outcome, then the user-friendliness of measurement tools, as well as their reliability and validity, will be critical to their widespread adoption.
Clinicians are already overburdened with paperwork, and adding to this load by requiring repeated detailed evaluations with such instruments as the Hamilton Rating Scale for Depression is unlikely to meet with success.