Self-reports vs clinician ratings of efficacies of psychotherapies for depression: a meta-analysis of randomized trials
Miguel C, Harrer M, Karyotaki E, Plessen CY, Ciharova M, Furukawa TA, Cristea IA, Cuijpers P (2025)
Publication Type: Journal article
Publication year: 2025
Journal
Book Volume: 34
Pages Range: e15-
DOI: 10.1017/S2045796025000095
Abstract
AIMS: The comparability between self-reports and clinician-rated scales for measuring depression following treatment has been a long-standing debate, with studies finding mixed results. While the use of self-reports in psychotherapy trials is very common, it has been widely assumed that these tools pose a validity threat when masking of participants is not possible. We conducted a meta-analysis across randomized controlled trials (RCTs) of psychotherapy for depression to examine if treatment effect estimates obtained via self-reports differ from clinician-rated outcomes. METHODS: We identified studies from a living database of psychotherapies for depression (updated to 1 January 2023). We included RCTs measuring depression at post-treatment with both a self-report and a clinician-rated scale. As our main model, we ran a multilevel hierarchical meta-analysis, resulting in a pooled differential effect size (Δg) between self-reports and clinician ratings. Moderators of this difference were explored through multimodel inference analyses. RESULTS: A total of 91 trials (283 effect sizes) were included. In our main model, we found that self-reports produced smaller effect size estimates compared to clinician-rated instruments (Δg= 0.12; 95% CI: 0.03-0.21). This difference was very similar when only including trials with masked clinicians (Δg= 0.10; 95% CI: 0.00-0.20). However, it was more pronounced for unmasked clinical ratings (Δg= 0.20; 95% CI: -0.03 to 0.43) and when trials targeted specific population groups (e.g., perinatal depression) (Δg= 0.20; 95% CI: 0.08-0.32). Effect sizes between self-reports and clinicians were identical in trials targeting general adults (Δg= 0.00; 95% CI: -0.14 to 0.14). CONCLUSIONS: Self-report instruments did not overestimate the effects of psychotherapy for depression and were generally more conservative than clinician assessments. Patients' perception of improvement should not be considered less valid by default, despite the inherent challenge of masking in psychotherapy.
Authors with CRIS profile
Involved external institutions
Technische Universität München (TUM)
Germany (DE)
Vrije Universiteit Amsterdam (VU) / University Amsterdam
Netherlands (NL)
Kyoto University / 京都大学 Kyōto daigaku
Japan (JP)
University of Padua / Universita degli Studi di Padova
Italy (IT)
Germany (DE)
Vrije Universiteit Amsterdam (VU) / University Amsterdam
Netherlands (NL)
Kyoto University / 京都大学 Kyōto daigaku
Japan (JP)
University of Padua / Universita degli Studi di Padova
Italy (IT)
How to cite
APA:
Miguel, C., Harrer, M., Karyotaki, E., Plessen, C.Y., Ciharova, M., Furukawa, T.A.,... Cuijpers, P. (2025). Self-reports vs clinician ratings of efficacies of psychotherapies for depression: a meta-analysis of randomized trials. Epidemiology and Psychiatric Sciences, 34, e15-. https://doi.org/10.1017/S2045796025000095
MLA:
Miguel, Clara, et al. "Self-reports vs clinician ratings of efficacies of psychotherapies for depression: a meta-analysis of randomized trials." Epidemiology and Psychiatric Sciences 34 (2025): e15-.
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