Major depressive disorder (MDD) is the foremost cause of disability across the globe, affecting about 20% of women and 10% of men in the U.S. alone. (1,2) Patients suffer a wide range of symptoms affecting all areas of their lives such as feelings of sadness, emptiness, or hopelessness, irritability, changes in diet, trouble concentrating or making decisions, sleep disturbances, and even thoughts of self-harm.3 Depression involves not only the traditional, emotional distress but can also lead to functional impairments that permeate into home, work, school, and social relationships.1
Fortunately, several treatment options are available to treat depression. These include both psychosocial options such as cognitive-behavioral therapies (CBT) or interpersonal psychotherapy and antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs).(1-3) Typically, a patient’s response to treatment is evaluated by clinician- or patient-reported rating scales predominantly based on symptom assessments.2
However, emerging challenges within the field demand attention. Engagement and retention of individuals in treatment programs present two opportunities for improvement. One meta-analysis study reports that as low as 27.6% of patients with MDD engage in care, with some populations at even higher risk for poor treatment engagement. Furthermore, only 40-50% of those who do initially seek treatment remain in treatment to completion. Ultimately, untreated and undertreated patients with depression remain a public health concern.1
What contributes to poor engagement and retention in depression care? Arguments could be made for broad issues such as insurance coverage. However, research is suggesting treatment approach as a contributing factor. A new perspective on incorporating patient-centered care, and more specifically, a patient’s individual preferences, needs, and values into treatment decisions shows promise.1 Clinicians certainly aim to incorporate patient goals within the scope of treatment but perhaps research can provide better tools and information. Such care could improve treatment outcomes by decreasing patient drop-out and increasing patient satisfaction with outcomes.
What are some of these patient goals? One study sought to find that very answer.2 This preliminary, qualitative study evaluated clinical trial records for patients receiving outpatient psychotherapy for depression. All patients were asked to list three long-term goals in key life areas. The researchers annotated these personal treatment goals specified by the patients and three major areas emerged. The first category, social and family goals, includes such ideas as making new friends, improving family relationships, and reconnecting with past contacts. The next major category, occupational and financial goals, mentioned items like finding a job, changing careers, and managing finances. The last major category included goals about personal health, organizing or cleaning one’s home, or addressing spiritual beliefs.1
The Goal Attainment Scale adapted for depression (GAS-D) is a complementary tool that focuses on recovery-oriented outcomes that patients consider vital to their well-being.2 This approach assesses a patient’s expectations from treatment by measuring results against specific, measurable, attainable, relevant, and time-bound (SMART) goals.2 Progress toward these goals can be converted to a standardized T score, allowing for scientific comparisons. This goal setting improves patient engagement with clinicians and health care providers. New data shows that this GAS-D scale shows convergence with multiple commonly used clinical measures of depression, indicating its validity.2 Additionally, this GAS-D approach allows patients to provide input into the design of their personalized treatment plan within a framework in which their progress can be assessed. This is one useful tool clinicians and healthcare professionals can use to overcome issues of treatment engagement and retention.
In summary, depression is a widespread disease affecting millions of people worldwide. Enrollment and retention in treatment programs continue to be challenging in the scope of depression treatment. Better tools can aid clinicians and health care providers in treating individual patient needs. Instruments such as the GAS-D scale supply the framework for a collaborative conversation between patient and doctor, aligning both on treatment goals and priorities. Often, these goals extend beyond simple symptom control to include improvements to daily, functional aspects of life. Acknowledgment of these more practical goals can lead to better patient engagement and progress in treatment plans, ultimately yielding to a healthier population.
- Battle CL, Uebelacker L, Friedman MA, Cardemil EV, Beevers CG, Miller IW. Treatment goals of depressed outpatients: a qualitative investigation of goals identified by participants in a depression treatment trial. J Psychiatr Pract. 2010;16(6):425-430. doi:10.1097/01.pra.0000390763.57946.93
- McCue M, Sarkey S, Eramo A, François C, Parikh SV. Using the Goal Attainment Scale adapted for depression to better understand treatment outcomes in patients with major depressive disorder switching to vortioxetine: a phase 4, single-arm, open-label, multicenter study [published correction appears in BMC Psychiatry. 2022 Mar 7;22(1):170] [published correction appears in BMC Psychiatry. 2022 Jun 8;22(1):388]. BMC Psychiatry. 2021;21(1):622. Published 2021 Dec 11. doi:10.1186/s12888-021-03608-1
- Mayo Clinic. Depression (major depressive disorder). Updated February 3, 2018. Accessed July 11, 2022. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007