Since its inception in 2008, the Service has based recovery on changes in score, on primarily the PHQ-9. With a proclaimed 50% recovery rate. The instrument, administered at each treatment session, guided treatment decisions as to whether to discharge a client or not and was usually the only feedback to GP s. But according to, a just published study in JAMA Psychiatry, the instrument has now been found to be largely invalid, with over half of patients not properly understanding what they’re being asked. The services self-audit cannot be taken seriously.
My own independent assessment of 90 patients, Scott (2018) using a standardised diagnostic interview suggested only a tip-of the-iceberg level of recovery. The PHQ-9 confuses, the frequency of a symptom with how bothered the person is by the symptom. Manea et al (2017) suggest that there are researcher allegiance effects in the original validation studies. When studies conducted by those who were not instrumental in the development of the PHQ-9 were considered, the test had a sensitivity of 0.48, half that found in the allegiance studies.
Who is responsible for the implosion? Systemic failures in Government to hold NHS Talking Therapies accountable, wishing instead to appear on the side of the angels /voters. Nobody daring to explain why £2billion a year spent on Adult and Child Services. Effectively a gift to Santa!
Dr Mike Scott