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Logo of bmcpsycBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Psychiatry
 
BMC Psychiatry. 2011; 11: 83.
Published online May 14, 2011. doi:  10.1186/1471-244X-11-83
PMCID: PMC3118175
The clinical global impression scale and the influence of patient or staff perspective on outcome
Thomas Forkmann,corresponding author1 Anne Scherer,1 Maren Boecker,1 Markus Pawelzik,2 Ralf Jostes,2 and Siegfried Gauggel1
1Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Aachen, Germany
2EOS Hospital for Psychotherapy, Münster, Germany
corresponding authorCorresponding author.
Thomas Forkmann: tforkmann/at/ukaachen.de; Anne Scherer: ascherer/at/ukaachen.de; Maren Boecker: mboecker/at/ukaachen.de; Markus Pawelzik: pawelzik/at/eos-klinik.de; Ralf Jostes: jostes/at/eos-klinik.de; Siegfried Gauggel: sgauggel/at/ukaachen.de
Received February 11, 2011; Accepted May 14, 2011.
Abstract
Background
Since its first publication, the Clinical Global Impression Scale (CGI) has become one of the most widely used assessment instruments in psychiatry. Although some conflicting data has been presented, studies investigating the CGI's validity have only rarely been conducted so far. It is unclear whether the improvement index CGI-I or a difference score of the severity index CGI-S dif is more valid in depicting clinical change. The current study examined the validity of these two measures and investigated whether therapists' CGI ratings correspond to the view the patients themselves have on their condition.
Methods
Thirty-one inpatients of a German psychotherapeutic hospital suffering from a major depressive disorder (age M = 45.3, SD = 17.2; 58.1% women) participated. Patients filled in the Beck Depression Inventory (BDI). CGI-S and CGI-I were rated from three perspectives: the treating therapist (THER), the team of therapists involved in the patient's treatment (TEAM), and the patient (PAT). BDI and CGI-S were filled in at admission and discharge, CGI-I at discharge only. Data was analysed using effect sizes, Spearman's ρ and intra-class correlations (ICC).
Results
Effect sizes between CGI-I and CGI-S dif ratings were large for all three perspectives with substantially higher change scores on CGI-I than on CGI-S dif. BDI dif correlated moderately with PAT ratings, but did not correlate significantly with TEAM or THER ratings. Congruence between CGI-ratings from the three perspectives was low for CGI-S dif (ICC = .37; Confidence Interval [CI] .15 to .59; F30,60 = 2.77, p < .001; mean ρ = 0.36) and moderate for CGI-I (ICC = .65 (CI .47 to .80; F30,60 = 6.61, p < .001; mean ρ = 0.59).
Conclusions
Results do not suggest a definite recommendation for whether CGI-I or CGI-S dif should be used since no strong evidence for the validity of neither of them could be found. As congruence between CGI ratings from patients' and staff's perspective was not convincing it cannot be assumed that CGI THER or TEAM ratings fully represent the view of the patient on the severity of his impairment. Thus, we advocate for the incorporation of multiple self- and clinician-reported scales into the design of clinical trials in addition to CGI in order to gain further insight into CGI's relation to the patients' perspective.
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