Abstract
This paper introduces a “blue pyjama syndrome” (whereby wearing hospital pyjamas results in an exaggerated impression of severity). We performed a 5-day, prospective, randomized, cross-over study in a French mood disorder unit for inpatients. At Day 1 (D1) and Day 5 (D5), two 5-minute video interviews were recorded with patients in pyjamas or in day clothes (the sequence was randomly allocated). Psychiatrists unaware of the study objective assessed the videos and scored their clinical global impressions (CGI, with scores ranging from 1 to 7). Of 30 participants with major depressive episode selected for inclusion, 26 participants (69% women) provided useable data for an evaluation by 10 psychiatrists. Pyjamas significantly increased the psychiatrists’ CGI ratings of disease severity by 0·65 [0·27; 1·02] points. The psychiatrists’ global impressions also rated patients as significantly less severe at D5 in comparison with D1 by −0·66 [−1·03; −0·29] points. The “blue pyjama syndrome” is in the same order of magnitude as the difference observed after a week of hospitalisation. This potentially calls into question the reliability and validity of observer ratings of depression.
Highlights
We report on a study on the reliability of assessments in psychiatry aiming to better understand subjective measurement processes in major depressive episodes (MDE), by exploring the existence of the “blue pyjama syndrome”, and quantifying its impact
The videos were randomly assigned to each psychiatrist using the following rules: 1/ Each video was to be seen by two psychiatrists; 2/ Each psychiatrist was to see an imbalanced distribution (3:7 or 4:7 OR 7:3 or 7:4) of patients in pyjamas or in day clothes; 3/ Each psychiatrist was to see only one video for each patient
For 2 patients, the second video was not useable due to technical problems and 2 patients left the hospital before the Day 5 (D5) assessment
Summary
Psychiatrists from the same team as the investigators were not included in order 1/ to avoid them assessing their own patients and 2/ to be sure that they would not guess the study design. The videos were randomly assigned to each psychiatrist using the following rules: 1/ Each video was to be seen by two psychiatrists; 2/ Each psychiatrist was to see an imbalanced distribution (3:7 or 4:7 OR 7:3 or 7:4) of patients in pyjamas or in day clothes (this artifice was to avoid awakening the psychiatrists’ attention to the study objective); 3/ Each psychiatrist was to see only one video for each patient This second computer-generated randomisation list was prepared by the methodologist and sent to the investigator who prepared the videos for each psychiatrist. The sponsor had no role concerning the preparation, review, or approval of the manuscript
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