Remission in depressed outpatients: More than just symptom resolution?

Abstract

Objective In treatment studies of depression remission is defined according to scores on symptom severity scales. Normalization of functioning has often been mentioned as an important component of the definition of remission, though it is not used to identify remitted patients in studies of treatment efficacy. Conceptually, the return of normal functioning should be as fundamental to the concept of remission as is symptom resolution because the presence of both symptoms and impaired functioning are core constructs in the diagnosis of mental disorders. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we examined the independent and additive association between level of severity of depressive symptoms and functional impairment in predicting depressed patients’ subjective evaluation of their remission status. Methods Five hundred and fourteen depressed psychiatric outpatients filled out a questionnaire on which they rated the severity of the symptoms of depression, the level of impairment due to depression, and their quality of life. Results Symptom severity, functional impairment from depression, and quality of life were significantly and highly intercorrelated, and each was significantly associated with remission status. The results of a logistic regression analysis indicated that each of the three variables was a significant, independent, predictor of remission status. Discussion In treatment studies of depression remission is narrowly defined in terms of symptom resolution. Our results support broadening the concept of remission beyond symptom levels to include assessments of functioning and quality of life.