Couldn’t resist it eh 😆

we couldn't disentangle this in our analyses. We used a sophisticated method to find trial-level predictors of the difference between self-reports and clinician ratings, but this doesn't work for the rating and instrument type. And of course, this is all observational data subject to confounding.

Thanks a lot Eiko! I am looking forward to your thoughts. We tried to look for trials where the same version of the instrument was employed as self-rated and observer-rated. e.g., MADRS, QIDS, IDS offer this possibility. But we did not find any eligible trials with such possibility, so unfortunately

Special thanks to @mathiasharrer.bsky.social for sharing this journey, and many thanks to our co-authors Eirini Karyotaki, @cyplessen.bsky.social, Marketa Ciharova, @toshi-frkw.bsky.social, @ioanaacristea.bsky.social, and @pimcuijpers.bsky.social for their continuous guidance and support!

5/ Self-report instruments do not overestimate the effects of psychotherapy for depression and might be more conservative than clinician assessments. Our findings support the validity of patient perspectives in evaluating treatment outcomes.

4/ Across 91 RCTs (283 effect sizes from multiple measurements), self-reports produced smaller effect size estimates compared to clinician-rated instruments (Δg = 0.12; 95% CI: 0.03–0.21). This difference was more pronounced for unmasked clinician ratings (Δg = 0.20; 95% CI: −0.03 to 0.43)

3/ We included trials measuring depression at post-treatment using both self-reports (e.g., BDI) and clinician ratings (e.g., HRDS). We ran a multilevel hierarchical meta-analysis, resulting in a pooled differential effect size (Δg) between self-reports and clinician ratings.

2/ pose a validity threat when masking of participants is not possible. We conducted the largest study to date examining systematic differences in effect estimates between self-reports and clinician assessments across RCTs on psychotherapy for depression.

1/ The comparability between self-reports and clinician-rated scales for measuring depression after treatment has been debated for years. Studies show mixed results, and while self-reports are common in psychotherapy trials, it is often assumed that these tools