Determination of a clinically important difference and definition of a responder threshold for the UCSD performance-based skills assessment (UPSA) in patients with major depressive disorder

Philip D Harvey, William Jacobson, Wei Zhong, George G. Nomikos, Christina Kurre Olsen, Elizabeth Merikle, Michael Cronquist Christensen

Research output: Contribution to journalArticle

10 Scopus citations


Background This article reports an evaluation of the psychometric properties and clinically important difference (CID) threshold of the UCSD Performance-Based Skills Assessment (UPSA) in major depressive disorder (MDD), using data from a large-scale study of the effects of vortioxetine on cognitive functioning and functional capacity in MDD patients. Methods Adults with moderate-to-severe recurrent MDD and self-reported cognitive dysfunction were randomized to 8 weeks of double-blind treatment with vortioxetine 10/20 mg QD (flexible), duloxetine 60 mg QD, or placebo. Pearson correlation coefficients were calculated between UPSA composite score and demographic/disease characteristics at baseline to examine construct validity. Two methods (distribution-based and anchor-based) were used to establish a CID threshold. Results A total of 602 patients were randomized; 528 comprised the full analysis set. For the entire sample mean UPSA composite scores were 77.8 at baseline and 83.9 at week 8 (mean change, +6.1). As hypothesized, at baseline, the UPSA composite score correlated with cognitive functioning (Digit Symbol Substitution Test: r=0.36, P<0.001) and workplace productivity (Work Limitations Questionnaire: r=–0.17, P=0.008), but not depressive symptoms (Montgomery-Åsberg Depression Rating Scale: r=0.02, P=0.707) or subjective cognitive dysfunction (Perceived Deficits Questionnaire: r=–0.02, P=0.698). Limitations Two versions of the UPSA were used and no inclusion/exclusion criteria were based on the UPSA. Conclusions These results support the construct validity of UPSA for assessing functional capacity independent of mood symptoms. The estimated CID for changes in UPSA scores was quite consistent at +6.4 points and +6.7 based on distribution-based and anchor-based methods, respectively.

Original languageEnglish (US)
Pages (from-to)105-111
Number of pages7
JournalJournal of Affective Disorders
StatePublished - Apr 15 2017



  • Clinically important difference
  • Cognitive dysfunction
  • Functional capacity
  • Major depressive disorder (MDD)
  • UCSD Performance-Based Skills Assessment (UPSA)

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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