Mood profile evaluation by families, young physicians and experienced psychiatrists in an actual clinical practice setting.

The purpose of this study was to explore differences in mood profile evaluation between raters with different backgrounds. Special emphasis was placed on expertise factor, influence of mood categories, and patient heterogeneity in a clinical setting. We administered Profile of Mood Scale (POMS) to patients' families, residents, and experienced psychiatrists as well as the patients, asking them to make an evaluation based on their image of the patients' subjective mood experience. Subscale scores and within-case across-item agreement indices among the raters were submitted for analysis. Analysis of variance of the subscale score showed significant effects of the rater by subscale-category and the rater by case components. The former was most influenced by the Vigor/Activity subscale in which the families and patients had higher scores than the physicians. As for rater-to-patient correlations of the score, psychiatrists were superior to residents in Anger/Hostility and Fatigue/Inertia, while families were superior to physicians in Vigor/Activity. These results suggest significance of expertise in mood evaluation as well as importance of time shared with the patients. The within-case across-item agreement data were subjected to cluster and canonical discriminant analysis. The analysis revealed four clusters which were best explained by two dimensions, one interpreted as general feasibility of evaluation and the other as characteristic emotional expression which caused separation of evaluation between families and physicians. Rater's expertise is a significant factor. Attention should also be paid to mood categories and patient heterogeneity.