Goal Attainment Scaling for Depression: Validation of the Japanese GAS-D Tool in Patients with Major Depressive Disorder

Abstract

Purpose

Goal attainment scaling (GAS) has been proposed as a person-centric, semi-quantitative measure that assimilates achievement of individually set goals into a single standardized “goal attainment score” that can be compared at the population level. We aimed to examine the reliability and validity of the Japanese version of the GAS for depression (GAS-D) tool in assessing goal attainment in people living with major depressive disorder (MDD).

Patients and Methods

This was a prespecified analysis of a prospective, 24-week, multicenter, observational cohort study of employed Japanese outpatients with MDD initiating treatment with vortioxetine according to the Japanese label (JRCT1031210200). Participants were assessed using the Japanese version of the GAS-D and other clinical rating scales at baseline and Weeks 8, 12 and 24.

Results

Goal attainment was significantly associated with symptom severity as assessed by the Montgomery–Åsberg Depression Rating Scale (MADRS) scale, confirming convergent validity. In particular, GAS-D scores were significantly related to MADRS total score at Weeks 12 and 24, indicating that improvements in overall symptom severity with vortioxetine treatment were likely to be reflected in the achievement of individualized treatment goals. With an intraclass correlation coefficient of 0.67 (95% CI 0.45–0.82), the GAS-D also showed moderate test–retest reliability between Weeks 8 and 12 while proving independent of demographic characteristics.

Conclusion

The results of this open-label study support the use of the GAS-D as a valid and sensitive outcome measure in the assessment of treatment response in MDD.

Keywords:

• major depressive disorder
• goal attainment scaling
• goal setting
• validation
• vortioxetine

Abbreviations

CGI-C, Clinicians Global Impression of Change; DSST, digit symbol substitution test; FAS, full analysis set; GAS-D, Goal Attainment Scale for Depression; ICC, Intraclass Correlation Coefficient; MADRS, Montgomery and Åsberg Depression Rating Scale; MDD, major depressive disorder; MDE, major depressive episode; MMRM, mixed model for repeated measures; ODQ, Oxford Depression Questionnaire; PDQ-D-5, Perceived Deficits Questionnaire-Depression 5-item; PGI-C, Patients Global Impression of Change; REML, restricted maximum likelihood; SDS, Sheehan Disability Scale; WPAI, Work Productivity and Activity Impairment questionnaire.

Prior Presentation

The abstract of this paper was presented in Japanese at the 44^th Japanese Society of Biological Psychiatry as a poster presentation with interim findings. The poster’s abstract was published online (https://jglobal.jst.go.jp/en/detail?JGLOBAL_ID=201709010666645249).

Data Sharing Statement

The authors confirm that the data supporting the findings of this study are available within the article. The authors may be contacted for further data sharing.

Acknowledgments

The original version of GAS-D (©2017 Takeda Pharmaceuticals USA, Inc. All rights reserved) was translated into Japanese by Lundbeck Japan K.K. with permission from Takeda Pharmaceuticals USA, Inc. The Japanese version of GAS-D (GAS-D-J) was created by Lundbeck Japan K.K. through translation and modifications of the original version of GAS-D. Medical writing assistance was provided by Anita Chadha-Patel of ACP Clinical Communications (Hertfordshire, UK) and was supported by H Lundbeck A/S.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Masaki Kato has received grant funding from the Ministry of Health, Labor and Welfare of Japan, the Japan Society for the Promotion of Science, SENSHIN Medical Research Foundation and Japan Agency for Medical Research and Development, Japan Research Foundation for Clinical Pharmacology, and speaker’s honoraria from Sumitomo Pharma Co., Otsuka Pharmaceutical Co., Meiji-Seika Pharma Co., Eli Lilly, MSD K.K, Pfizer, Janssen Pharmaceutical, Shionogi Inc, Mitsubishi Tanabe Pharma Corp., Takeda Pharmaceutical, Lundbeck Japan, Viatris, Eisai, Kyowa Pharmaceutical Inc., and Ono Pharmaceutical; and is a consultant and/or advisory board member for Sumitomo Pharma Co., Otsuka Pharmaceutical Co., Lundbeck Japan, Takeda Pharmaceutical, and Shionogi Inc., outside the submitted work. Toshiaki Kikuchi has received manuscript fees or speaker’s honoraria from Eisai, Meiji Seika Pharma Co., Mitsubishi Tanabe Pharma Corp., MSD, Otsuka Pharmaceutical Co., Viatris, Sumitomo Pharma Co., Takeda Pharmaceutical, Lundbeck Japan, and Yoshitomi; and is a consultant and advisory board member for Takeda Pharmaceutical and Lundbeck Japan. Koichiro Watanabe has received manuscript fees or speaker’s honoraria from Astellas, Daiichi Sankyo, GlaxoSmithKline, Janssen Pharmaceuticals, Kyowa Pharmaceutical Industry Co., Lilly, Meiji Seika Pharma Co., Mitsubishi Tanabe Pharma Corp., MSD, Otsuka Pharmaceutical Co., Pfizer, Shionogi Inc., Sumitomo Pharma Co., Takeda Pharmaceutical, and Yoshitomi; has received research and grant support from Astellas, Daiichi Sankyo, Eisai, Meiji Seika Pharma Co., Mitsubishi Tanabe Pharma Corp., Mochida Pharmaceutical, MSD, Otsuka Pharmaceutical Co., Pfizer, Sumitomo Pharma Co., Shionogi Inc. and Takeda Pharmaceutical; is a consultant for Eisai, Janssen Pharmaceutical, Kyowa Pharmaceutical, Lilly, Mitsubishi Tanabe Pharma Corp., Otsuka Pharmaceutical Co., Pfizer, Sumitomo Pharma Co., and Taisho Toyama Pharmaceutical; and is a consultant and/or advisory board member for Takeda Pharmaceutical, Lundbeck Japan, Boehringer Ingelheim, Luye Pharma, and Viatris, outside the submitted work. Tomiki Sumiyoshi has received manuscript fees, speaker’s honoraria, consultation fees, and/or grant support from Janssen Pharmaceuticals, Meiji Seika Pharma, Takeda Pharmaceutical, Otsuka Pharmaceutical, Sumitomo Pharma, Shionogi Pharma, Lundbeck Japan, Boehringer Japan, and VeraSci. Yoshiya Moriguchi is an employee of Lundbeck Japan K.K. Daniel Oudin Åström and Michael Cronquist Christensen are employees of H. Lundbeck A/S.

Additional information

Funding

This study was funded by H Lundbeck A/S.