Koen Demyttenaere1, Anne-Françoise Donneau2, Adelin Albert2, Marc Ansseau3, Eric Constant4, Kees van Heeringen5. 1. University Psychiatric Centre, University of Leuven, Campus Gasthuisberg, Leuven, Belgium. Electronic address: koen.demyttenaere@med.kuleuven.be. 2. Department of Medical Informatics and Biostatistics, University of Liège, CHU Sart Tilman, Liège, Belgium. 3. Department of Psychiatry and Medical Psychology, University and CHU of Liège, CHU Sart-Tilman, Liège, Belgium. 4. Department of Psychiatry, Catholic University of Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. 5. University Department of Psychiatry and Medical Psychology, Unit for Suicide Research, University of Ghent Hospital, Ghent, Belgium.
Abstract
AIMS: The influence of discordance in what is important in being cured from depression on clinical outcome at 6 months, assessed with a divergence index. METHODS: 304 outpatients treated for depression by general practitioners or by psychiatrists and completing a 6-month treatment period: a divergence index (divergence between physician and patient view on what is important in being cured from depression) was calculated for each physician-patient pair. The relation between this index and outcome at 6 months was analyzed (including depressive, anxious and somatic symptom severity, positive effect, functional impairment and quality of life (psychological and social relations). RESULTS: Response rates (50% improvement) were 65.9% for depressive symptomatology and 46.2% for anxious symptomatology. The subgroup with a poor physician-patient agreement (highest quartile) on expectations had a worse clinical outcome than the subgroup with an excellent physician-patient agreement (lowest quartile): differences in response rate between these groups ranged from 9% to 27%; this difference reached statistical significance for 3 outcome variables (anxiety, positive effect and social relationships). CONCLUSIONS: The study shows that outcomes with standard antidepressant drugs are still suboptimal and that discordance between what patients׳ and physicians׳ consider important in the definition of cure from depression significantly influences clinical outcomes at 6 months.
AIMS: The influence of discordance in what is important in being cured from depression on clinical outcome at 6 months, assessed with a divergence index. METHODS: 304 outpatients treated for depression by general practitioners or by psychiatrists and completing a 6-month treatment period: a divergence index (divergence between physician and patient view on what is important in being cured from depression) was calculated for each physician-patient pair. The relation between this index and outcome at 6 months was analyzed (including depressive, anxious and somatic symptom severity, positive effect, functional impairment and quality of life (psychological and social relations). RESULTS: Response rates (50% improvement) were 65.9% for depressive symptomatology and 46.2% for anxious symptomatology. The subgroup with a poor physician-patient agreement (highest quartile) on expectations had a worse clinical outcome than the subgroup with an excellent physician-patient agreement (lowest quartile): differences in response rate between these groups ranged from 9% to 27%; this difference reached statistical significance for 3 outcome variables (anxiety, positive effect and social relationships). CONCLUSIONS: The study shows that outcomes with standard antidepressant drugs are still suboptimal and that discordance between what patients׳ and physicians׳ consider important in the definition of cure from depression significantly influences clinical outcomes at 6 months.
Authors: Mario Maj; Dan J Stein; Gordon Parker; Mark Zimmerman; Giovanni A Fava; Marc De Hert; Koen Demyttenaere; Roger S McIntyre; Thomas Widiger; Hans-Ulrich Wittchen Journal: World Psychiatry Date: 2020-10 Impact factor: 49.548