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The importance of functional impairment to mental health outcomes: A case for reassessing our goals in depression treatment research
Open accessAbstract
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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In the citing paper
“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
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“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)”
In the citing paper
“which may explain in part why social impairments persist following established treatments.(4, 5)”
In the citing paper
“improvements in positive affect and well-being tend to be smaller and lag behind reductions in clinical symptoms following established treatments.(4, 5, 34)”
In the citing paper
“Because social disconnection is common across a wide range of psychiatric conditions and existing treatments leave room for improvement for many patients in this domain (Hofmann et al., 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
In the citing paper
“Because social disconnection is common across a wide range of psychiatric conditions and existing treatments leave room for improvement for many patients in this domain (Hofmann et al., 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
In the citing paper
“since the presence of unresolved mental health symptoms can limit improvements in other domains [96, 97].”
From Patient-reported outcome measures for life engagement in mental health: a systematic review (2022) · cites this paper as [96]
In the citing paper
“improvement in functional outcomes that reflect life engagement may lag behind symptomatic improvement”
From Patient-reported outcome measures for life engagement in mental health: a systematic review (2022) · cites this paper as [96]
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Metadata
- Authors
- McKnight, P. E., & Kashdan, T. B.
- Affiliations
- George Mason University (US)
- Corresponding author
- McKnight, Patrick E.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2009-04
- Volume
- 29
- Issue
- 3
- Pages
- 243-259
- ISSN
- 0272-7358 (ISSN-L)
- 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
- 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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