When evaluating treatment outcomes among patients with depression, the focus of research should go beyond symptom resolution by incorporating both patients’ and clinicians’ perspectives in the development of measurable endpoints. A qualitative study published in BJPsych Open collected data from focus group interviews in order to stimulate the exchange of views and experiences between patients.
The investigators sought to examine relevant outcomes of treatment for depression in specialist care from the perspectives of both patients and clinicians, and to explore whether these perspectives actually differ from each other. Patients and clinicians in the specialist mental health care setting were chosen for purposive sampling.
In order to be eligible for study participation, patients had to meet the following criteria: have or have had a depressive disorder as their main diagnosis; had experience with treatment for depression; and be willing to share their experiences on treatment for depression in a focus group. Clinicians were eligible for study participation if they treat or have treated patients with depressive disorders and were willing to share their views in a semistructured interview. A total of 18 individuals were eligible for participation—12 patients and 7 clinicians—with 1 of the patients withdrawing from the study.
Overall, 4 focus group interviews were conducted in 3 focus groups from November 2016 through June 2017. The first interview was a pilot, in which the interviewers were unable to disclose all topics in the interview guide. Thus, the participants were ultimately interviewed a second time, in order to discuss the additional topics in the interview guide and to verify all results from the first interview. The following topics were included in the interview guide:
1) personal experiences with depression treatment and goals of therapy; 2) outcomes used during treatment; and 3) perspectives on the definition of remission or treatment success for treatment evaluation.
Of the 11 patients who were interviewed, 8 were women and 3 were men, with the age range of the patients being 22 to 69 years. A total of 9 patients were currently receiving treatment for their depression, with the other 2 patients either in remission or having completed their treatment at the time of the focus group interview. Of the 7 clinicians, 6 were women and 1 was a man, and their age range was 32 to 64 years.
The majority of patients mentioned goals associated with social functioning and interpersonal relationships as important components of treatment for depression. Normalization of social functioning, which was deemed important, included getting out of bed, continuing normal activities, and functioning as prior to the depression. Undertaking activities with family and friends once again was considered to be a good indicator of social functioning.
Clinicians also perceived restoring social functioning and interpersonal relations, regaining quality of life, and attaining personal goals as being important for patients with depression. They also highlighted symptom reduction and satisfaction with treatment as being relevant outcomes, with these themes not as important among patients. Furthermore, patients clearly distinguished between treatment outcomes in first-time depression vs recurrent/chronic depression, whereas clinicians did not.
The investigators concluded that goal-setting seems to be an important component of treatment evaluation regarding outcomes in depression from both the patients’ and the clinicians’ perspectives. When treatment efficacy is measured in terms of value-based endpoints, treatment outcomes become more meaningful and improvement in treatment success rates become attainable.
Kan K, Jörg F, Buskens E, Schoevers RA, Alma MA. Patients’ and clinicians’ perspectives on relevant treatment outcomes in depression: qualitative study. BJPsych Open. 2020;6(3):e44. doi: 10.1192/bjo.2020.27.