The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research

McKnight, Patrick E.; Kashdan, Todd B.

doi:10.1016/j.cpr.2009.01.005

Cited by 400Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsMental Health Research Topics

The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research

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McKnight, Patrick E., Kashdan, Todd B.·2009·Clinical Psychology Review

DOI 10.1016/j.cpr.2009.01.005PMC PMC2814224

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Abstract

Outcomes in depression treatment research include both changes in symptom severity and functional impairment. Symptom measures tend to be the standard outcome but we argue that there are benefits to considering functional outcomes. An exhaustive literature review shows that the relationship between symptoms and functioning remains unexpectedly weak and often bidirectional. Changes in functioning often lag symptom changes. As a result, functional outcomes might offer depression researchers more critical feedback and better guidance when studying depression treatment outcomes. The paper presents a case for the necessity of both functional and symptom outcomes in depression treatment research by addressing three aims-1) review the research relating symptoms and functioning, 2) provide a rationale for measuring both outcomes, and 3) discuss potential artifacts in measuring functional outcomes. The three aims are supported by an empirical review of the treatment outcome and epidemiological literatures.

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The available literature differed vastly in sampling methods and survey instruments, capturing different conceptualisations of severity with no general consensus in distinguishing between mild, moderate, and severe states of MDD.
“Moreover, the available literature differed vastly in sampling methods and survey instruments hence capturing different conceptualisations of severity with no general consensus in distinguishing between mild, moderate, and severe states of MDD [41].”
From Burden of depressive disorders by country, sex, age, and year: findings from the Global Burden of Disease Study 2010 (2013) · cites this paper as [41]
First-line psychosocial treatments produce modest improvements in social functioning, falling short of much larger changes observed for symptoms.
“First-line psychosocial treatments produce modest improvements in social functioning – falling short of much larger changes observed for symptoms,(4–6) with social disconnection persisting after symptoms remit.(1)”
From Amplification of Positivity Treatment for Anxiety and Depression: A Randomized Experimental Therapeutics Trial Targeting Social Reward Sensitivity to Enhance Social Connectedness (2024) · cites this paper as [5]
Social impairments persist following established treatments.
“which may explain in part why social impairments persist following established treatments.(4, 5)”
From Amplification of Positivity Treatment for Anxiety and Depression: A Randomized Experimental Therapeutics Trial Targeting Social Reward Sensitivity to Enhance Social Connectedness (2024) · cites this paper as [5]
Improvements in positive affect and well-being tend to be smaller and lag behind reductions in clinical symptoms following established treatments.
“improvements in positive affect and well-being tend to be smaller and lag behind reductions in clinical symptoms following established treatments.(4, 5, 34)”
From Amplification of Positivity Treatment for Anxiety and Depression: A Randomized Experimental Therapeutics Trial Targeting Social Reward Sensitivity to Enhance Social Connectedness (2024) · cites this paper as [5]
Evidence-based treatments for anxiety and depression produce only modest improvements in social connectedness.
“Contemporary treatments for anxiety and depression improve facets of social connectedness; however, improvements tend to be modest and do not match the much larger changes typically observed for symptoms (Eng, Coles, Heimberg, & Safren, 2005; Hofmann, Wu, & Boettcher, 2014; McKnight & Kashdan, 2009).”
From Enhancing social connectedness in anxiety and depression through amplification of positivity: Preliminary treatment outcomes and process of change (2020) · cites this paper as McKnight & Kashdan, 2009

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Bech P 1998 Quality of life in the psychiatric patient London Mosby-Wolfe
Hatfield E Cacioppo J Rapson R 1994 Emotional contagion New York Cambridge University Press
Paykel E 1999 Social functioning and the depressed patient International Journal of Psychiatry in Clinical Practice 3 1 S9 S11

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Authors: McKnight, P. E., & Kashdan, T. B.
Affiliations: George Mason University (US)
Corresponding author: McKnight, Patrick E.
ORCID: McKnight, Patrick E.
Kashdan, Todd B.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2009-04
Volume: 29
Issue: 3
Pages: 243-259
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2009.01.005
PMC: PMC2814224
OpenAlex: W1971568036
Cited by: 400
References: 223
Citations by year: 2026: 30 · 2025: 29 · 2024: 27 · 2023: 19 · 2022: 43 · 2021: 34 · 2020: 31 · 2019: 31 · 2018: 19 · 2017: 24 · 2016: 30 · 2015: 25 · 2014: 18 · 2013: 20 · 2012: 6
FWCI: 0.99
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (R21MH073937, MH-73937)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR047595)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords: depression, functional disability, mental health outcomes, symptom severity, treatment outcome measures, measurement artifacts
MeSH terms: Depressive Disorder, Major, Major Depressive Disorder, Employment, Feedback, Goals, Health Status, Humans, Psychology, Research, Social Behavior

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The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research

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