Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review

Abstract

Remission can best be defined as a less symptomatic state than previously assumed (Hamilton Rating Scale for Depression, 17-item version (HAMD-17) ⩽4 instead of ⩽7), without applying a duration criterion. Duration thresholds to separate remission from recovery are not meaningful. The minimal duration of depressive symptoms to define a depressive episode should be longer than 2 weeks, although further studies are required to recommend an exact duration threshold. These results are relevant for researchers and clinicians aiming to use evidence-based depression outcomes.

Dynamic system perspectives on anxiety and depression

“…In short, depressed adolescents are characterized by negative views of themselves, the world, and their future, and uncontrollable self-critical cognitions, which impede their ability to generate positive affect (Gotlib & Joorman, 2010;Rutter et al, 2011). Mood states typically last for weeks to months and have a relatively constant quality even though the state itself is dynamic, and this progression from normal affect fluctuations to entrenchment is what characterizes mood as a developmental process (De Zwart et al, 2018;Lewis, 2000;Rutter et al, 2011).…”

“…Definite proof of generic early warning signals for the onset of anxiety or depression episodes requires researchers to monitor many individuals with high-frequency assessments over a long period in advance of the transition under studyand because such data has been collected with compliance rates of 80% and up (see Hoenders et al, 2012;Wichers et al, 2016Wichers et al, , 2018Schiepek et al, 2016), in the near future we expect studies that show whether the idea of warning signals has substance, and result in the implementation of prevention strategies. At the group-level the timing of such discrete transitions in depressive symptom severity is inconsistent (De Zwart et al, 2018) which indicates substantial individual variability and sudden changes; This is illustrated in Figure 7.1, which shows the recovery trajectory of 267 participants over 140 weeks in terms of their depressive symptoms (a 50% symptom reduction after 30 weeks) and demonstrates how uninformative group-level indicators can be for individual patterns. The idea of non-linear shifts in symptom severity combined with large individual variability favors knowledge on how symptoms evolve at the level of the individual in daily life to elucidate mechanisms, because the underlying causes are probably individualspecific (Fisher et al, 2018;Yang et al, 2018).…”

What is the threshold for a clinical minimally important drug effect?

“…A recent evaluation proposed that the best estimate for being asymptomatic or in remission would be ≤4 points on the HRSD 11. Firm cut-off scores for mild, moderate and severe depression have not been established, but many authors define 9–16 HRSD points as mild depression, 17–24 as moderate depression and ≥25 points as severe depression.…”

“…If a statistical model is inadequate, the probability of an observed effect under the assumption of this model has no relevance. An inadequate assumption could for instance be that any score higher than 0 on the HRSD, such as for instance 2 or 3 points, indicates that someone is depressed (remember that patients with ≤4 points on the HRSD are considered non-depressed) 11. Therefore, the American Statistical Association further states, ‘A p-value, or statistical significance, does not measure the size of an effect or the importance of a result,’ and they emphasise, ‘Any effect, no matter how tiny, can produce a small p -value if the sample size or measurement precision is high enough…’ (p 132) 14…”

Female undergraduate dental students may present higher depressive symptoms: A systematic review

“…Dental students showed a varied prevalence of depressive symptoms, from 9.9% to 71.1%. Sociodemographic characteristics, socioeconomic factors (Hysenbegasi et al, 2005), and different methods of depression assessment (de Zwart et al, 2018) may account for the varied prevalence. Despite this varied prevalence of symptoms, strategies to help with coping and management of this condition should be performed in dental education (Basudan, Binanzan, & Alhassan, 2017).…”