Measurement-Based Psychiatric Treatment to Improve Outcomes

I’m a consulting psychiatrist in the general hospital and therefore always pressed for time. Bedside interviews on medical-surgical units are always quick and focused because they’re geared to meet the needs of more than one customer, the patient always being the main one of course. However, I have often found it helpful to add a rating scale or two to help confirm my clinical impression based on thin-slicing during the blazing fast face-to-face assessment. When I was assessing patients in the outpatient clinic, I could nearly alway find time to administer at least one rating scale, usually one for depression. These would tell me specifically what symptoms bothered my patients the most, and would tell me not only how depressed they were, but in some cases would let me know their view of their quality of life. I always got the impression that my patients appreciated my taking the time to assess them a bit more thoroughly and it would give us something more concrete to target in terms of symptoms relief and help operationalize what treating depression to remission actually means to them.

The sites I often use to download free and open access depression rating scales that are validated and relatively brief are easy to get into and out of and don’t bother me with advertisements and complicated username/password gates. One of them I use and recommend to learners is Outcome Tracker, built by Dr. Mark Zimmerman at Brown University in Rhode Island, link Dr. Zimmerman is the principal investigator of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS). You can use the rating scales free of charge or pay a fee for the site to track your outcomes for you in this web-based system, yielding reports for you and your patients. I frequently use the Clinically Useful Depression Outcome Scale (CUDOS) and highly recommend this site.

I have also used free and open access downloadable depression rating scales from IDS/QIDS at link For example, the Quick Inventory of Depressive Symptomatology-16 (this is the brief 16 item version) allows the patient and clinician to track depression severity over time and makes evaluations more specific and goal-directed. The QIDS and variations are available in several languages.

Both the QIDS-SR 16 and the CUDOS are well-validated and help me feel like I’m on firmer ground when assessing whether treatment is working or not. I was even able to track patient progress on our electronic health record by copy-pasting an Excel graph of scores from different appointments. It was a nice way to find something specific to work on rather than relying on the quick and vague “Hi, how are you feeling?” generalities of the typical clinic visit.