Patients’ and clinicians’ perspectives on relevant treatment outcomes in depression: qualitative study

Abstract

Background Although symptomatic remission is considered the optimal outcome in depression, this is not always achieved. Furthermore, symptom indicators do not fully capture patients’ and clinicians’ perspectives on remission. Broader indicators of (partial) remission from depression should be considered. Aims To investigate relevant outcomes of depression treatment in specialist care from patients’ and clinicians’ perspectives and to investigate whether these perspectives differ from each other. Method Three focus groups with 11 patients with depression and seven semi-structured interviews with clinicians were conducted exploring their perspectives on remission. All interviews were audio-recorded and transcribed verbatim. We analysed the transcripts thematically using the phenomenologist approach. Results Independently, both patients and clinicians perceived the following outcomes relevant: restoring social functioning and interpersonal relations, regaining quality of life and achieving personal goals. All clinicians emphasised symptom reduction and satisfaction with treatment as relevant outcomes, whereas the former was not an obvious theme in patients. Unlike clinicians, patients made a clear distinction between treatment outcomes in first versus recurrent/chronic depression. Conclusions Classically defined study outcomes based on symptom resolution only partly reflect issues considered important by patients and clinicians in specialist depression treatment. Incorporating patients’ and clinicians’ perspectives in the development of measurable end-points makes them more suitable for use in trials and subsequent translation to clinical practice. Furthermore, evaluating patients’ perspectives on treatment outcomes helps in the development of tailored interventions according to patients’ needs.

Effectiveness of Vortioxetine in Patients With Major Depressive Disorder in Real-World Clinical Practice: Results of the RELIEVE Study

“…Clinician-rated scales, such as the Montgomery-Åsberg Depression Rating Scale or the Hamilton Depression Rating Scale, are often used to assess the efficacy of antidepressant treatment in clinical trial settings, while the Functioning Assessment Short Test (FAST) may be used for the clinical evaluation of functional impairment in patients with MDD. However, clinician-rated scales may not fully capture a patient's subjective experience of MDD and antidepressant treatment, and patients' perceptions of symptoms and treatment outcomes in MDD have been shown to differ from those of their clinicians (76)(77)(78)(79)(80). Furthermore, most clinician-rated scales that are short, easy and applicable for routine care are interview-based.…”

Emotional blunting in patients with depression. Part III: relationship with psychological trauma

“…Furthermore, patients were significantly more likely than HCPs to think that psychological trauma was a reason for their depression and that their depression was more severe because of it. Other studies have shown clinically relevant differences between patient and HCP perceptions of depression [ 45 – 47 ]. Nevertheless, the possibility that patients may have overestimated the potential impact of their experience of psychological trauma on their depression cannot be excluded.…”

Patient Expectations and Experiences of Antidepressant Therapy for Major Depressive Disorder: A Qualitative Study

“…These findings are consistent with other research that has been conducted into the bothersome symptoms and impact of MDD on the lives of patients. 21 , 25–29 …”