Why do some depressed outpatients who are not in remission according to the hamilton depression rating scale nonetheless consider themselves to be in remission?

BACKGROUND: In treatment studies of depression, remission is typically defined narrowly-based on scores on symptom severity scales. Patients treated in clinical practice, however, define the concept of remission more broadly and consider functional status, coping ability, and life satisfaction as important indicators of remission status. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined how many mildly symptomatic depressed patients in ongoing treatment who did not score in the remission range on the 17-item Hamilton Depression Rating Scale (HAMD) nonetheless considered themselves to be in remission from their depression. Among the mildly symptomatic HAMD nonremitters, we compared the demographic and clinical characteristics of patients who did and did not consider themselves to be in remission.
METHODS: We interviewed 274 psychiatric outpatients diagnosed with DSM-IV major depressive disorder who were in ongoing treatment. The patients completed measures of psychosocial functioning and quality of life.
RESULTS: Approximately one-quarter of the patients scoring 8-12 on the HAMD considered themselves to be in remission. Compared to patients who did not consider themselves to be in remission, the remitters reported significantly better quality of life, less functional impairment due to depression, higher positive mental health scores, and better coping ability. DISCUSSION: Some patients who do not meet symptom-based definitions of remission nonetheless consider themselves to be in remission. The findings raise caution in relying exclusively on symptom-based definitions of remission to guide treatment decision making in clinical practice.