Why Do Some Depressed Outpatients Who Are in Remission According to the Hamilton Depression Rating Scale Not Consider Themselves to Be in Remission?
ABSTRACT In treatment studies of depression, remission is typically defined narrowly, based on scores on symptom severity scales. Patients treated in clinical practice, however, define the concept of remission more broadly and consider functional status, coping ability, and life satisfaction as important indicators of remission status. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined how many depressed patients in ongoing treatment who scored in the remission range on the 17-item Hamilton Depression Rating scale (HDRS) did not consider themselves to be in remission from their depression. Among the HDRS remitters, we compared the demographic and clinical characteristics of patients who did and did not consider themselves to be in remission.
From March 2009 to July 2010, we interviewed 274 psychiatric outpatients diagnosed with DSM-IV major depressive disorder who were in ongoing treatment. The patients completed measures of depressive and anxious symptoms, psychosocial functioning, and quality of life.
Approximately one-half of the patients scoring 7 and below on the HDRS (77 of 140 patients for whom self-reported remission status was available) did not consider themselves to be in remission. The self-described remitters had significantly lower levels of depression and anxiety than the patients who did not consider themselves to be in remission (P < .001). Compared to patients who did not consider themselves to be in remission, the remitters reported significantly better quality of life (P < .001) and less functional impairment due to depression (P < .001). Remitters were significantly less likely to report dissatisfaction in their mental health (P < .01), had higher positive mental health scores (P < .001), and reported better coping ability (P < .001).
Some patients who meet symptom-based definitions of remission nonetheless experience low levels of symptoms or functional impairment or deficits in coping ability, thereby warranting a modification in treatment. The findings raise caution in relying exclusively on symptom-based definitions of remission to guide treatment decision-making in clinical practice.
- 01/2012; 10(4):434-441. DOI:10.1176/appi.focus.10.4.434
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ABSTRACT: A 38-year-old woman presents with major depression of I year's duration. She has missed a few days of work during the past month, has not been keeping up with usual household responsibilities, and has withdrawn from friends and social engagements. At the initial evaluation, she scores in the upper end of the moderate range of severity on a self-report depression scale. After 3 months of treatment, she feels much better. She is tolerating the medication well. In the past month, she has missed no days from work, completed her household chores, and engaged in more social activities (though is not fully back to her usual level). Her score on the depression scale improved by 60% after 2 months, although it did not fall into the remission range. That is, she responded to treatment, but continued to have residual symptoms. Her score at the 3-month visit is the same as at the 2-month visit. At the 3-month visit, she is not interested in increasing her medication dosage, adding another medication, or seeing a therapist.The Journal of Clinical Psychiatry 09/2012; 73(9):1262-3. DOI:10.4088/JCP.12ac08081 · 5.14 Impact Factor
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ABSTRACT: Current standards for treating major depressive disorder (MDD) recommend that achieving remission should be considered the principal goal of treatment. Recent research suggests that the symptom-based definitions of remission used in efficacy studies do not adequately reflect the perspective of depressed patients receiving treatment in routine clinical settings. We developed the Remission from Depression Questionnaire (RDQ) to capture the broader array of domains considered by patients to be relevant to the construct of remission-symptoms of depression, nondepressive symptoms, features of positive mental health, coping ability, functioning, life satisfaction and a general sense of well-being. The current report is the first study of the reliability and validity of the RDQ. The test-retest reliability of the RDQ was studied in 60 depressed outpatients in ongoing treatment. The convergent and discriminant validity of the RDQ was studied in 274 depressed outpatients who were rated on the 17-item Hamilton Depression Scale (HAM-D) and who completed several self-report scales including the Quick Inventory of Depressive Symptomatology (QIDS). The RDQ demonstrated excellent internal consistency, with a Cronbach's α of .97 for the total scale and above .80 for each of the 7 subscales. The test-retest reliability of the total scale was .85 and above .60 for each subscale. Both the RDQ and QIDS were significantly associated with patients' self-reported remission status. However, the RDQ remained significantly associated with remission status after controlling for QIDS scores (r = -.32, p < .001) whereas the QIDS was not associated with remission status after controlling for RDQ scores (r = -.06). The RDQ is a reliable and valid measure that evaluates the multiple domains that depressed patients consider important in determining remission. The results are consistent with prior research suggesting that depressed patients' perspective of remission goes beyond symptom resolution.Journal of Psychiatric Research 10/2012; 47(1). DOI:10.1016/j.jpsychires.2012.09.006 · 4.09 Impact Factor