A paper published in Psychotherapy and Psychosomatics (P&P) analyzes the measures that are chosen as outcome in psychiatric trials and questions their clinical validity.
The Authors advocate the use of simpler measures and more ecologically valid designs to answer the central questions on how do we know if one treatment works better than another, and who is going to benefit of such treatments. As highlighted by Arfken and Balon, the use of valid and reliable scales plays an essential role in research. However, the scales commonly used in psychiatry are difficult to understand. This is mainly due to the fact that most measures used in psychiatry do not provide simple and understandable answers for the public. Hence, the need to develop outcomes that are understandable to patients, families and policymakers is impending. Also, efficacious treatments should not be restricted to specialized centers or specialists. The process of identification and treatment or referrals of psychiatric disorders by primary care practitioners should be widely practiced. Instead, primary care practitioners intervene dispensing medications to people with psychiatric disorders, making medications even more widely used. The Authors pointed out that relevant information for patients, families and society, are those related to mortality, functioning, health care utilization and quality of life. Practitioners need this information, as well as, clinical measures that capture clinical signs and symptoms to evaluate the progression and severity of diseases.
More ecologically valid trials, defined as a simple protocol mimicking routine clinical practice and eligibility criteria, and trials of longer duration with mortality as the outcome would provide more reliable information.