title: Functional impairment in patients with major depression in clinical remission: results from the VIVAL-D-Rem, a nationwide, naturalistic, cross-sectional survey.
abstract: In recent years, the standard for successful treatment of major depression has switched from response to remission; however, little is known about patients who have achieved remission, but still have some residual symptoms and whether they regain previous levels of functioning. In a large, nationwide, cross-sectional, naturalistic survey (VIVAL-D) of 907 patients with major depression treated with a new course of an antidepressant in 41 Italian community psychiatric centers, patients with a Hamilton Rating Scale for Depression, 17-item version (HAM-D17) score up to 14 were selected (n=499). Of these, 169 were considered to be in remission (HAM-D17 ≤ 7) and the other 330 to be mildly depressed. Their level of functioning was evaluated using the SF-12. Only a few (3%) patients in remission were completely symptom free; most were affected by residual symptoms. Patients in remission had better SF-12 scores than those with mild depression, but their functioning was significantly worse than general population norms. In the logistic regression analysis, the HAM-D17 total score and individual items were predictive of poor functioning. Analysis of sensitivity and specificity values showed that a lower cut-off score (4/5) of the HAM-D17 scale was best for predicting poor performance so that a reconsideration of the usual cut-off for remission of 7/8 for HAM-D17 seems overdue.
authors.affiliation: aDepartment of Clinical and Experimental Sciences, Brescia University School of Medicine bUniversity Psychiatric Unit, Department of Mental Health, Brescia Spedali Civili, Brescia cDepartment of Systems Medicine, University Tor Vergata, Rome dDepartment of Pharmacological and Biomolecular Sciences, University of Milano, Milano, Italy eDepartment of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Emilio
authors.initials: E
authors.lastname: Sacchetti
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.forename: Alberto
authors.initials: A
authors.lastname: Siracusano
authors.forename: Giorgio
authors.initials: G
authors.lastname: Racagni
authors.forename: Antonio
authors.initials: A
authors.lastname: Vita
authors.forename: Cesare
authors.initials: C
authors.lastname: Turrina
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies / Q000379:methods; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000592:standards; D020127:Recovery of Function; D012074:Remission Induction / Q000379:methods
chemical_list: D000928:Antidepressive Agents