Recall accuracy for the symptoms of a major depressive episode among clinical trial participants

For patients with major depressive disorder (MDD), approaches to treatment differ for those with a single versus recurrent episodes. Based on studies of community samples, however, accuracy is low for identifying past episodes. Recall accuracy among clinical samples with a well-defined major depressive episode (MDE) has not been examined previously. We evaluated episode recall accuracy in 79 MDD patients in follow-up of the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study at 12- and 24-month time-points after starting treatment. Using the Structured Clinical Interview for DSM-IV, patients were asked to recall whether they had been experiencing the nine criterion symptoms of an MDE at the time of their intake assessment. Accuracy of recall for the index MDE was high, with 95% of patients at month 12 and 85% at month 24 recalling sufficient symptoms to meet the diagnostic criteria. Recall accuracy for specific symptoms varied considerably, from > 90% for dysphoria and anhedonia, to 55% for psychomotor and weight/appetite changes. For the thoughts of death/suicide criterion, patients with erroneous recall were significantly more likely to recall having had the symptom at the intake evaluation (though they had denied it at the time) than vice versa (p < .007). Patients who have participated in a clinical trial are likely to recall accurately a past MDE up to two years prior. Optimal vigilance for suicidal ideation for treatment-naive patients should include a combination of self-report and clinician assessments.