Differing Patient and Provider Perspectives May Hinder Treatment Strategies for MDD

counseling, therapy
Across all 3 disease phases, patients reported experiencing a wider range of MDD symptoms and a greater impairment in functioning compared with reports from HCPs.

Patients and healthcare providers (HCPs) differ with respect to their perceptions of symptoms of major depression disorder (MDD) and their effect on psychosocial functioning across all stages of the condition, according to study results published in Frontiers in Psychiatry.

A detailed analysis of data from an online survey conducted between February 14 and March 28, 2017, among patients with MDD and HCPs (ie, primary care physicians, neurologists, and psychiatrists), was conducted in 8 countries—Brazil, Canada, France, Italy, Mexico, South Korea, Spain, and the United States. The investigators sought to explore the relationship between various symptoms of MDD across different phases of the disease (acute, postacute, and remission).

Participants needed to be ≥18 years of age (≥25 years of age in the United States) and have a profile that was indicative of a history of depression during the prior 12 months. All patients verified that they had been diagnosed with depression by an HCP and were either currently using prescribed antidepressant medication for their depression or had used medication to treat their depression within the past 3 months. Data on MDD symptoms and psychosocial functioning were evaluated via an adapted version of the Functioning Assessment Short Test (FAST) scale. All data were derived from use of an online survey received from a total of 2008 patients diagnosed with MDD (according to their personal experience with the disorder) and 3138 patients observed by 1046 HCPs (according to patient records).

Multivariate regression analysis was used to render correlations between patient-reported and HCP-reported symptoms of MDD and psychosocial functioning impairment. The population for this analysis included 1946 patient respondents and 3042 HCP-reported patients, with 62 and 96 patients, respectively, having been excluded from the 2 cohorts because they had missing FAST total scores.

Across all 3 disease phases, patients reported experiencing a wider range of MDD symptoms and a greater impairment in functioning compared with reports from HCPs. With respect to mood symptoms, significant associations were observed in the patient-reported cohort for “lack of interest in general” in the acute phase and for “low self-esteem” in the remission phase of the disease (P <.05 for both).

In the HCP-reported cohort, significant associations were observed for “feelings of guilt or worthlessness” and “suicidal thoughts” in the acute phase (P <.05 for both), for “low self-esteem” in the postacute phase (P <.05), and for “lacking in confidence” in the remission phase (P <.05). Furthermore, significant associations were observed for ≥1 cognitive symptom and functioning in both cohorts during all phases of the disease.

The investigators concluded that the findings from this study show that patients emphasized cognitive, rather than mood and physical symptoms, in the acute phase of the disease, whereas HCPs were more likely than patients to correlate more specific physical symptoms with functioning during the remission stage of the disease.

Overall, the findings emphasize the need for improved communication between patients and HCPs in order to establish “appropriate treatment goals” for patients with MDD.


Christensen MC, Wong CMJ, Baune BT. Symptoms of major depressive disorder and their impact on psychosocial functioning in the different phases of the disease: do the perspectives of patients and healthcare providers differ? [published online April 24, 2020]. Front Psychiatry. doi: 10.3389/fpsyt.2020.00280.