October 2020
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Full text: Tracy, D., Joyce, D., Albertson, D., & Shergill, S. (2020). Kaleidoscope. The British Journal of Psychiatry, 217(4), 593-594. doi:10.1192/bjp.2020.155
Read the full October 2020 Kaleidoscope column in BJPsych for free
Measurement matters in depression, but ‘average global changes’ in depression scales can mask important individual symptom improvements. Besides this, there is a more fundamental question of what such scales should explore in the first place. Chevance et al undertook international sampling across 52 countries to determine which outcomes mattered most to patients (n = 1912), caregivers (n = 464) and professionals (n = 627).1 There is inevitably a selection bias in such work, but the open-ended online answers clustered into domains of: symptoms (n = 64) including mental pain and motivation; functioning (n = 16), including social isolation; and other domains (n = 57) indirectly related to treatment benefits, including diverse areas of intervention safety, improved service access and reducing stigma. Symptom improvement matters, but is often the clinicians’ and researchers’ primary focus, whereas social functioning can lag a long way behind. The authors note how seldom the issues identified here are included in the most commonly used depression scales in clinical trials; yet they matter to those with the actual condition, and those who care for them. It is fascinating that at the tail end of 2020, this is the first large-scale study on the topic.