A new study finds incongruity in how clinicians describe a “remission from depression,” compared to how clients describe their improved mental health.
Mark Zimmerman, M.D., a Rhode Island Hospital research director, found that patients suffering from major depressive disorder (MDD) describe remission as improved life satisfaction and a sense of well-being.
But clinicians view remission from a symptom-based standpoint, placing emphasis on the presence or absence of clinical signs.
This incongruity may lead to insufficient intervention or an overuse of scarce resources.
“Current standards for treating major depressive disorder recommend that achieving remission should be considered the principal goal of treatment,” said Zimmerman.
“But recent studies have shown that patients and clinicians view remission differently. To determine the best approach to achieving a level of remission satisfactory to the patient, we developed the Remission from Depression Questionnaire to measure the components of depression that patients feel are most important.”
The Remission from Depression Questionnaire (RDQ) includes questions about symptoms of depression, non-depressive symptoms, features of positive mental health, coping ability, functioning, life satisfaction and a general sense of well-being.
This is the first study of the reliability and validity of the RDQ. The study concluded that the RDQ is a reliable and valid measure that evaluates multiple domains that depressed patients consider important to determining remission. The results are consistent with prior research, suggesting that depressed patients’ perspective of remission goes beyond symptom resolution.
Two studies were conducted: the first including 100 psychiatric outpatients being treated for MDD in the Rhode Island Department of Psychiatry outpatient practice; and the second examined 274 outpatients receiving ongoing treatment for MDD at the hospital’s outpatient residency training clinic.
The Rhode Island Hospital outpatient psychiatric group predominantly treats individuals with medical insurance on a fee-for-service basis, and it is distinct from the hospital’s outpatient residency training clinic that predominantly serves lower income, uninsured and medical assistance patients.
Findings from use of the new questionnaire (RDQ) confirm that symptom-based definitions of remission used in efficacy studies do not adequately reflect the perspective of depressed patients receiving treatment in routine clinical settings.
“More work must be done to broaden the definition of remission,” Zimmerman said.
“Our patients need to feel supported, they need to feel confident about their remission. Therefore, it’s imperative that clinicians and patients work more closely together to more clearly define remission in order to achieve the best outcomes for these patients.
“If some of the symptoms appear to be alleviated, but the patient is still suffering from a poor sense of well-being and low life satisfaction, then there is still more work to do.”
Zimmerman reports his findings in a paper published online in advance of print in the Journal of Psychiatric Research.