title: What is important in being cured from: does discordance between physicians and patients matter? (2).
abstract: OBJECTIVE
  The influence of discordance in what is important in being cured from depression on clinical outcome at 6 months, assessed with a divergence index.
  
  
  METHODS
  304 outpatients treated for depression by general practitioners or by psychiatrists and completing a 6-month treatment period: a divergence index (divergence between physician and patient view on what is important in being cured from depression) was calculated for each physician-patient pair. The relation between this index and outcome at 6 months was analyzed (including depressive, anxious and somatic symptom severity, positive effect, functional impairment and quality of life (psychological and social relations).
  
  
  RESULTS
  Response rates (50% improvement) were 65.9% for depressive symptomatology and 46.2% for anxious symptomatology. The subgroup with a poor physician-patient agreement (highest quartile) on expectations had a worse clinical outcome than the subgroup with an excellent physician-patient agreement (lowest quartile): differences in response rate between these groups ranged from 9% to 27%; this difference reached statistical significance for 3 outcome variables (anxiety, positive effect and social relationships).
  
  
  CONCLUSIONS
  The study shows that outcomes with standard antidepressant drugs are still suboptimal and that discordance between what patients׳ and physicians׳ consider important in the definition of cure from depression significantly influences clinical outcomes at 6 months.
authors.affiliation: University Psychiatric Centre, University of Leuven, Campus Gasthuisberg, Leuven, Belgium. Electronic address: koen.demyttenaere@med.kuleuven.be.
authors.forename: Koen
authors.initials: K
authors.lastname: Demyttenaere
authors.affiliation: Department of Medical Informatics and Biostatistics, University of Liège, CHU Sart Tilman, Liège, Belgium.
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Donneau
authors.affiliation: Department of Medical Informatics and Biostatistics, University of Liège, CHU Sart Tilman, Liège, Belgium.
authors.forename: Adelin
authors.initials: A
authors.lastname: Albert
authors.affiliation: Department of Psychiatry and Medical Psychology, University and CHU of Liège, CHU Sart-Tilman, Liège, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Ansseau
authors.affiliation: Department of Psychiatry, Catholic University of Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Constant
authors.affiliation: University Department of Psychiatry and Medical Psychology, Unit for Suicide Research, University of Ghent Hospital, Ghent, Belgium.
authors.forename: Kees
authors.initials: K
authors.lastname: van Heeringen
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D034462:Dissent and Disputes; D005500:Follow-Up Studies; D058005:General Practitioners / Q000523:psychology; D006801:Humans; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry; D011788:Quality of Life; D063189:Symptom Assessment; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressants; Depression; Expectations; Outcome