To the original 41-item questionnaire, the researchers added 19 items. The final 60-item questionnaire included the following:
- 14 depressive symptoms.
- 11 nondepressive symptoms.
- 5 coping ability/stress tolerance items (for instance, “I had trouble handling pressure”).
- 12 positive mental health items (for instance, “I saw myself as a person of value”).
- 10 functioning items (for instance, “I was socially withdrawn”).
- 8 general well-being/life satisfaction items (for instance, “I was engaging in life rather than hiding from it”).
Patients were divided into three groups:
- Symptom responders (whose scores on the RDQ depressive symptom subscale improved by ≥ 50% from admission to discharge).
- PGI responders, who weren’t symptom responders – that is, who reported global improvement but didn’t improve ≥ 50% on the depression symptom subscale.
- Nonresponders (that is, patients who didn’t respond on the PGI and the depressive symptom subscale).
The researchers compared the three groups on the four symptom domains of the RDQ. Patients also completed the PGI on discharge, and the researchers compared these responses to responses to the RDQ.
Only 38.7% were responders on the depressive symptoms subscale, while 67.4% were PGI responders.
Most patients (91.4%) who were responders on the depressive symptom subscale were also PGI responders, while 32% were PGI responders but not responders on the depressive symptom subscale.
Although 29.2% were nonresponders on both measures, 70.8% were responders on one scale or the other.
As far as the nonsymptom domains, response rates varied between 30% (life satisfaction) to 33.1% (positive mental health).
“If you’re using a measurement tool in practice, I’d recommend one that goes beyond symptom improvement and also captures broader domains,” Dr. Zimmerman said.
‘Better enough’
Commenting on the study, Philip Muskin, MD, professor of psychiatry, Columbia University Medical Center, New York, said the use of symptom-driven rating scales to measure depression response originated in mandates of the U.S. Food and Drug Administration to determine whether a drug being tested in a clinical trial is superior to placebo.
Columbia University Medical Center
Dr. Philip Muskin
“But there has been, for a long time, the question of whether these people are really better,” said Dr. Muskin, who was not involved with the current study. “Symptomatically, they may show improvement, but do they actually perceive themselves as better?”
Some patients might report, “I’m about 75% myself, but not back to 100%.” Dr. Muskin doesn’t “take these to be hard-and-fast numbers, but patients can tell you how they perceive themselves. This study suggests that if you’re wedded to [symptom measurement] scales, you may not realize that patients are actually getting better. And who decides if a patient is better, or better enough? The patient decides that.”
He added that some patients won’t achieve complete remission. “Even if I can’t get the person to be 100% better, I’m glad if I can help them become ‘better enough’ to function in life, do things, go to work, and improve in quality-of-life domains.”
The study received no outside funding. Dr. Zimmerman and his coauthor and Dr. Muskin report no relevant financial relationships.
A version of this article first appeared on Medscape.com.