Describing depression: congruence between patient experiences and clinical assessments.

OBJECTIVES:Efforts to describe depression have relied on top-down methods in which theory and clinical experience define depression but may not reflect the individuals' experiences with depression. We assessed the degree of overlap between academic descriptions of depression and patient-reported symptoms as conceptualized in the Patient-Reported Outcomes Measurement Information System(®) (PROMIS(®)). By extension, this work assesses the degree of overlap between current clinical descriptions of depression and patient-reported symptoms. DESIGN:In this content analysis study, four focus groups were conducted across two sites to elicit symptoms and the experience of depression from depressed and medically ill patients. METHODS:Depressed and medically ill patients were asked to describe symptoms that characterize depression. Data were transcribed and then coded using an a priori list of 43 facets of depression derived from extant depression measures. RESULTS:Participants described 93% of the symptoms from the a priori list, supporting the validity of current depression measures. Interpersonal difficulties were underscored as was anger. In general, results from the focus groups did not require the generation of new items for depression and supported the content validity of the PROMIS hierarchical framework and item pool created originally. CONCLUSIONS:This work supports the validity of current depression assessment, but suggests further investigation of interpersonal functioning and anger may add to the depth and breadth of depression assessment.