Differences Between Minimally Depressed Patients Who Do and Do Not Consider Themselves to Be in Remission
J Clin Psychiatry 2005;66(9):1134-1138
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Objective: We recently derived a cutoff on
a self-report scale corresponding to the most commonly used definition of remission in
depression treatment studies (i.e., Hamilton Rating Scale
for Depression [HAM-D] score < = 7). However, recent research has suggested that use of this
cutoff on the HAM-D to define remission is overinclusive. The goal of the present report
from the Rhode Island Methods to Improve
Diagnostic Assessment and Services (MIDAS) project was
to examine how many depressed patients in ongoing treatment who are considered to be in
remission by a self-report equivalent of the HAM-D
definition of remission nonetheless do not
consider themselves to be in remission.
Method: Five hundred thirty-five
psychiatric outpatients treated for a DSM-IV major
depressive episode were asked whether they
considered themselves to be in remission and completed
the Clinically Useful Depression Outcome Scale (CUDOS), a measure of the severity of the
DSM-IV symptoms of depression. The study was conducted from August 2003 until July 2004.
Results: Nearly one quarter of the
patients who met the remission threshold on the
CUDOS (55/249) did not consider themselves to be in
remission. Among the CUDOS remitters, the total score on the CUDOS was significantly
lower (p < .001) in patients who considered
themselves to be in remission than in patients who did
not indicate that they were in remission.
Examination of specific symptoms revealed greater
appetite disturbance and hypersomnia in the patients
who did not think they were in remission.
Conclusions: Our results suggest that
heterogeneity of clinical status exists even among
patients who are minimally depressed and considered to be in remission according
to contemporary definitions on symptom severity scales.