title: Discordance between self-reported symptom severity and psychosocial functioning ratings in depressed outpatients: implications for how remission from depression should be defined.
abstract: The diagnosis of depression is based on the presence of symptoms along with functional impairment. One might therefore expect the definition of remission of depressive disorder to be based on the resolution of both symptoms and functional impairments. This, however, is not how the field has been defining remission. Rather, in treatment studies of depression, remission has been defined in symptom terms only. Clinical experience suggests that there is sometimes discordance between patients' symptom severity and functioning. No studies, however, have examined the frequency of this discordance. We examined the concordance of ratings of depression symptom severity and psychosocial functioning in a sample of 503 outpatients receiving treatment for major depressive disorder. The majority of patients were concordant in these ratings (i.e. no symptoms and no functional impairment, or ongoing symptoms and impairment), though one quarter of the patients were discordant. Specifically, approximately one quarter of the patients with depressive symptoms denied concurrent psychosocial impairment. In contrast, it was rare for patients without symptoms to report functional impairment. Almost all patients without both symptoms and functional impairment considered themselves to be in remission, and almost all patients with both symptoms and functional impairment did not consider themselves to be in remission. Half of the patients who reported normal functioning despite ongoing depressive symptoms considered themselves to be in remission from their depression. This suggests that current symptom-based definitions of remission might be too narrow.
authors.affiliation: Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA. mzimmerman@lifespan.org
authors.forename: Mark
authors.initials: M
authors.lastname: Zimmerman
authors.forename: Joseph B
authors.initials: JB
authors.lastname: McGlinchey
authors.forename: Michael A
authors.initials: MA
authors.lastname: Posternak
authors.forename: Michael
authors.initials: M
authors.lastname: Friedman
authors.forename: Daniela
authors.initials: D
authors.lastname: Boerescu
authors.forename: Naureen
authors.initials: N
authors.lastname: Attiullah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011584:Psychology; D012074:Remission Induction; D012720:Severity of Illness Index; D012919:Social Behavior; D011795:Surveys and Questionnaires