Association of Self-Reported Clinical Behavior With Guideline Adherence in Schizophrenia and Major Depressive Disorder After Guideline Education.
13 affiliations
- 1Center for Health Control, Nara Medical University, Kashihara, Japan.
- 2Department of Psychiatry, School of Medicine, Nara Medical University, Kashihara, Japan.
- 3Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
- 4Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan.
- 5Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Toon, Japan.
- 6Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
- 7Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan.
- 8Department of Psychiatry, The Jikei University School of Medicine, Minato-ku, Japan.
- 9Department of Community Mental Health, Shinshu University School of Medicine, Matsumoto, Japan.
- 10Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan.
- 11Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.
- 12NHO Sakakibara National Hospital, Tsu, Japan.
- 13Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan.
Abstract
Background
The Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project is a nationwide Japanese educational program promoting guideline-concordant pharmacotherapy for schizophrenia and major depressive disorder (MDD). Psychiatrists' self-reported clinical behavior (CB) scores after EGUIDE training are partially associated with objective quality indicators of specific practices. However, their association with comprehensive objective measures of overall guideline adherence remains unclear.Methods
This multicenter observational study included 1897 EGUIDE-trained psychiatrists. CB was assessed online immediately after training. The Guideline Adherence Rate (GAR) was calculated for 5328 patients with schizophrenia and 3538 patients with MDD whose discharge records were linked to their psychiatrist's CB score. Associations were evaluated using unadjusted patient-level Spearman correlations, without modeling clustering within psychiatrists or institutions. Sensitivity analyses aggregated the data to the psychiatrist-year level, adjusted for institution type, psychiatrist experience, and patient age, and used generalized estimating equations (GEE) to correct the patient-level inference for clustering.Results
CB scores showed positive but very weak correlations with GAR (schizophrenia, ρ = 0.09-0.14; MDD, ρ = 0.08-0.11; all p < 0.001). Squared coefficients (approximately 0.006-0.020) indicated that CB scores accounted for < 2% of the rank-order variation in GAR. These associations remained statistically significant in psychiatrist-year-level, covariate-adjusted, and clustering-corrected (GEE) sensitivity analyses.Conclusions
Post-training self-reported CB scores were weakly associated with patient-level GAR. Given the cross-sectional, unadjusted analysis and the non-independence of patients treated by the same psychiatrist, these findings do not establish CB as a reliable proxy for actual clinical practice.Trial registration
University Hospital Medical Information Network Clinical Trials Registry, UMIN000022645.
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BibTeX
@article{yamamuro2026association,
title = {{Association of Self-Reported Clinical Behavior With Guideline Adherence in Schizophrenia and Major Depressive Disorder After Guideline Education.}},
author = {Kazuhiko Yamamuro and Hikaru Hori and Takashi Tsuboi and Shinichiro Ochi and Toru Horinouchi and Yasushi Kawamata and Keisuke Mori and Yusuke Arai and Kazutaka Ohi and Junya Matsumoto and Toshiaki Onitsuka and Koichiro Watanabe and Ken Inada and Norio Yasui-Furukori and Ryota Hashimoto},
journal = {Neuropsychopharmacology reports},
year = {2026},
month = nov,
doi = {10.1002/npr2.70179},
url = {https://europepmc.org/article/MED/42973217},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Association of Self-Reported Clinical Behavior With Guideline Adherence in Schizophrenia and Major Depressive Disorder After Guideline Education.
AU - Kazuhiko Yamamuro
AU - Hikaru Hori
AU - Takashi Tsuboi
AU - Shinichiro Ochi
AU - Toru Horinouchi
AU - Yasushi Kawamata
AU - Keisuke Mori
AU - Yusuke Arai
AU - Kazutaka Ohi
AU - Junya Matsumoto
AU - Toshiaki Onitsuka
AU - Koichiro Watanabe
AU - Ken Inada
AU - Norio Yasui-Furukori
AU - Ryota Hashimoto
PY - 2026
DA - 2026/11/04
JO - Neuropsychopharmacology reports
DO - 10.1002/npr2.70179
UR - https://europepmc.org/article/MED/42973217
AB - Background The Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project is a nationwide Japanese educational program promoting guideline-concordant pharmacotherapy for schizophrenia and major depressive disorder (MDD). Psychiatrists' self-reported clinical behavior (CB) scores after EGUIDE training are partially associated with objective quality indicators of specific practices. However, their association with comprehensive objective measures of overall guideline adherence remains unclear.Methods This multicenter observational study included 1897 EGUIDE-trained psychiatrists. CB was assessed online immediately after training. The Guideline Adherence Rate (GAR) was calculated for 5328 patients with schizophrenia and 3538 patients with MDD whose discharge records were linked to their psychiatrist's CB score. Associations were evaluated using unadjusted patient-level Spearman correlations, without modeling clustering within psychiatrists or institutions. Sensitivity analyses aggregated the data to the psychiatrist-year level, adjusted for institution type, psychiatrist experience, and patient age, and used generalized estimating equations (GEE) to correct the patient-level inference for clustering.Results CB scores showed positive but very weak correlations with GAR (schizophrenia, ρ = 0.09-0.14; MDD, ρ = 0.08-0.11; all p < 0.001). Squared coefficients (approximately 0.006-0.020) indicated that CB scores accounted for < 2% of the rank-order variation in GAR. These associations remained statistically significant in psychiatrist-year-level, covariate-adjusted, and clustering-corrected (GEE) sensitivity analyses.Conclusions Post-training self-reported CB scores were weakly associated with patient-level GAR. Given the cross-sectional, unadjusted analysis and the non-independence of patients treated by the same psychiatrist, these findings do not establish CB as a reliable proxy for actual clinical practice.Trial registration University Hospital Medical Information Network Clinical Trials Registry, UMIN000022645.
SN - 2574-173X
ER -