There was no evidence that health status was better on higher-than-recommended doses, but we cannot conclude that lower doses for some would have led to poorer outcomes. Physicians who believe that higher doses are more therapeutic for patients need to demand rigorous effectiveness research that tests whether there are benefits of higher doses and determine the ratio of those benefits to the clinical costs, including the risk of side effects.

BACKGROND Questions exist related to the best way to use medical evidence relative to self-report as part of the SSA disability determination process. OBJECTIVE To examine concordance between provider and claimant responses along the four dimensions of work related behavioral health functioning: Social Interactions, Mood and Emotions, Behavioral Control, and Self-Efficacy. METHODS Using secondary data from a larger study, which collected data on individuals reporting difficulties with work (claimants) due to mental conditions, 39 items were completed by claimants and their healthcare provider. Inter-rater agreement was assessed using three techniques: Cohen’s kappa, percent absolute agreement, and folded mountain plots. RESULTS A sample of 65 dyads was obtained. Inter-rater agreement was low for most items (k = 0.0–0.20) with a minority of items having fair agreement (k = 0.21–0.40) Percent agreement was fair: Mood and Emotions (46%), Self-Efficacy (44%), Behavioral Control (39%) and Social Interactions (38%). Overall, providers reported lower functioning compared to claimants for the Behavioral Control and Self-Efficacy scales; the reverse trend held for the Mood and Emotions scale. CONCLUSIONS Results indicate discordance between provider and claimant report of behavioral health functioning. Understanding reasons for and approaches to reconciling the inconsistencies between claimant and provider perspectives is a complex task. These findings have implications for how best to assess mental and behavioral-health related work disability in the absence of an established gold standard measure.

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