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Testing for response shift in treatment evaluation of change in self-reported psychopathology amongst secondary psychiatric care outpatients

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  • Ingrid V E Carlier
  • Wessel A van Eeden
  • Kim de Jong
  • Erik J Giltay
  • Martijn S van Noorden
  • Christina van der Feltz-Cornelis
  • Frans G Zitman
  • Henk Kelderman
  • Albert M van Hemert


Publication details

JournalInternational Journal of Methods in Psychiatric Research
DateAccepted/In press - 1 Apr 2019
DateE-pub ahead of print (current) - 17 Jun 2019
Number of pages14
Pages (from-to)e1785
Early online date17/06/19
Original languageEnglish


OBJECTIVES: If patients change their perspective due to treatment, this may alter the way they conceptualize, prioritize, or calibrate questionnaire items. These psychological changes, also called "response shifts," may pose a threat to the measurement of therapeutic change in patients. Therefore, it is important to test the occurrence of response shift in patients across their treatment.

METHODS: This study focused on self-reported psychological distress/psychopathology in a naturalistic sample of 206 psychiatric outpatients. Longitudinal measurement invariance tests were computed across treatment in order to detect response shifts.

RESULTS: Compared with before treatment, post-treatment psychopathology scores showed an increase in model fit and factor loading, suggesting that symptoms became more coherently interrelated within their psychopathology domains. Reconceptualization (depression/mood) and reprioritization (somatic and cognitive problems) response shift types were found in several items. We found no recalibration response shift.

CONCLUSION: This study provides further evidence that response shift can occur in adult psychiatric patients across their mental health treatment. Future research is needed to determine whether response shift implies an unwanted potential bias in treatment evaluation or a desired cognitive change intended by treatment.

Bibliographical note

© 2019 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd.

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