Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

An Analysis and Comparison of the Zhung Anxiety and Zhung Depression Scales with the Sheehan Disability, DSM-5 Self-Rated, and DSM-5 Clinician-Rated Scales Atul Ganta, B.A., M.A., OMS-II 1 , Kashfaa Tasmim, B.S., M.A., OMS-II 1 , Maggie Morehouse, B.A., OMS-II 1 , Damian Gluchowski,B.S. 1 , Patrick Leonard, B.S., OMS-II 1 , Zachary Fitzgerald, B.S., OMS-II 1 , Amanda Sanko, B.S., OMS-II 1 , Giovanni Reyes, B.S., OMS-II 1 , Robert Westbrook, B.S., M.A., OMS-II 1 , Andrew Walker, PhD, OMS-III 1 , J. Christopher Caston, MD 2 , JuliSu DiMucci-Ward, PhD 1 , Paul Switzer, MD, DHA. 1 1. Edward Via College of Osteopathic Medicine Departments of Clinical Medicine, Spartanburg, South Carolina. 2. Upstate Psychiatric Associates, Spartanburg, South Carolina Introduction Results Discussion

Accurate assessment of psychiatric disorders is crucial for effective diagnosis and treatment in clinical practice. Self-reported measures, such as the Zhung Anxiety and Depression Scales (ZADS), which quantifies anxiety and depression levels, serve as screening tools for physicians and are widely used due to the ease of administration and patient accessibility. 1 The Sheehan Disability Scale (SDS) measures the patient’s functional impairment impacting aspects of family, work, and social life. 4 The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure – Adult (DSM-5 SR) measures symptom presentation per 23 questions over 13 psychiatric domains to assess the presence and severity of mental disorders. These tools are validated and used by clinicians for screening and ongoing symptom tracking. However, uncertainty remains regarding the consistency of these self-reports with more rigorous clinician-rated diagnostic standards per chart review. This potential gap raises questions regarding validity of self-reported scales when used in isolation for clinical making decisions. Objective: We seek to investigate the relationship between the ZADS with the SDS and DSM-5 SR. Our goal is to examine the relationships between mental disorders, such as anxiety and depression, and overall impairment in daily life, focusing on how self-reported symptoms align with the DSM-5 SR symptom domains, as well as symptoms rated by a clinician. Our hypothesis is that the ZADS accurately compare with the DSM-5 CR showing a correlation that patients with more severe DSM-5 SR symptoms domains demonstrate a stronger negative impact on their daily living and a positive correlation with the independent clinician's rating.

How often was the patient self-rated DSM-5 scale in agreement with the clinician rated DSM-5 scale?

Conclusion This study examined the relationships between the ZADS, SDS, DSM-5 SR, and DSM-5 CR scales from 21 patient charts in an outpatient psychiatry practice. The data collected so far shows some agreement between the clinician-rated and the self-rated scales for several classifications including depression and substance abuse but demonstrated much less agreement for other classifications such as sleep problems. Patient perception also played a major role in creating a statistical difference between clinician-rated and self-rated in the cases of mania, repetitive thoughts and behaviors, and personality functioning due to the clinician not perceiving these symptoms as present, while the patient did. There was also a statistical difference with the patient's Zhung score for depression. • Why are some of the symptom domains in agreement while others are not? One possibility is that for symptom domains with lack of symptoms (e.g., suicidal ideation), majority of the patients did not have this symptom. • Using a board-certified psychiatrist as an independent reviewer helped validate the data and reduce bias, ensuring an impartial assessment. Study Limitations: • Patients were encouraged to complete the scales but still held the ultimate decision to decline. • Limited demographics; only self-referred private practice psychiatric patients. • Small sample size. Future Recommendations: • Examine a larger sample size by expanding the number of patients and including diverse populations to assist with generalizability. • Explore additional symptom categories for further validation and application. • Track symptom evolution and resolution of symptoms longitudinally. • Further explore and expand the correlation between the Zhung depression scale and Sheehan disability level. • The data demonstrates a positive correlation between clinician-rated and self reported depression, substance abuse, suicidal ideation, and psychosis using the DSM-5 CR and DSM-5 SR scales. • Patients reported having symptoms of anger, mania, repetitive thoughts and behaviors, and personality functioning, while the clinician did not rate them as having these symptoms. 2 • There were no symptoms domains that the clinician rated positively that the patient did not report. This could be likely due to physicians overestimating their patients' health and underestimating their symptoms • Patients with depression or both depression and anxiety demonstrated a positive correlation between clinician-rated and self-rated symptoms, compared to those with only anxiety. In medicine, physicians across the board rate patients' symptoms and pain as lower than the patients themselves. 5

Figure 1.1 and 1.2. Describing the similarity between the clinician-rated and self-rated DSM ratings. Setting alpha = 0.05 and m = 13, significance level = 0.00384 using Bonferroni correction.

The above data describes the similarity between the clinician-rated and self-rated DSM ratings. According to our data, the ratings that were in agreement with both the clinician-rated and self-rated DSM levels were depression and substance use (89.66% similar). The ratings that showed the least agreement was sleep problems (37.93% similar). We see that mania, repetitive thoughts & behavior & personality functioning significantly differ between the patient perception and independent psychiatrist perception. Were differences in the scales more commonly due to the physician not perceiving the symptom or the patient not perceiving the symptom?

Methods

Study Design: This study was a retrospective chart analysis utilizing 21 patient charts in a psychiatric outpatient office.

APA is way better

Figure 2. Showing the similarity and difference in each of the DSM classifications that were evaluated by the clinician and the patient. Bonferroni correction (m = 2) with alpha = 0.05.

Based on the data collected above, we see that there was a significant difference between clinician-rated and self-rated for the categories of mania, repetitive thoughts and behaviors, and personality functioning. The difference seems to be that clinician did not perceive these symptoms as being there, while the patient did. Does the Zhung scale for depression and anxiety correlate with the clinician’s impression of the existence of depression and anxiety?

Inclusion criteria: Ͳ Zhung Anxiety and Depression Scale (self-rated) ( ZADS). Ͳ Sheehan Disability Scale (self rated) ( SDS). Ͳ DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure – Adult ( DSM-5 SR).

Exclusion Criteria: - Incomplete patient information missing either ZADS, SDS, or DSM-5 SR scales

- Patient information that was unable to be made confidential

Process: 1. A board-certified psychiatrist independently reviewed the patient charts and noted key symptoms from the 13 domains listed on the DSM-5 SR. We termed this the DSM-5 Clinician-Rated Scale ( DSM-5 CR) . 2.Each patient had a diagnosis based on ICD-10 billing codes. A standardized data extraction was used to ensure consistency. All patient information was de identified to maintain confidentiality. 3.A comprehensive data analysis was conducted, and data points were generated using appropriate statistical methods to ensure reliability.

Figure 3.1 and 3.2. Showing the correlation of the clinician's impression of the existence of depression (top row) and anxiety (bottom row).

References

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Using a point correlation data, we see that a clinician-rated depression is statistically significant with the patient’s Zhung score for depression. However, this does not appear to be the same for anxiety.

2025 Research Recognition Day

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