The Functional Impact of Major Depressive Disorder on Patients' Daily Lives: A Qualitative Investigation of Patient and Clinician Perspectives
Background: Major Depressive Disorder (MDD) impacts functional capacity beyond core mood symptoms. Treatment strategies often prioritize symptom reduction over functional recovery. This study compared functional impacts and outcome priorities reported by patients with MDD and clinicians.
Methods: We conducted semi-structured interviews with 15 adults diagnosed with MDD (current or prior antidepressant use) and 5 clinicians who regularly treat individuals with MDD. Interviews focused on symptoms, functional impacts, and improvement priorities. Data were analyzed using standard qualitative methods.
Results: Patients most frequently identified fatigue (93.3%), sleep disturbances (86.7%), cognitive difficulties (86.7%; e.g. concentration and thinking), depressed mood (86.7%), and anxiety (86.7%) as MDD symptoms. Clinicians most commonly identified anhedonia (100%) and depressed mood (100%) as presenting symptoms. Patients reported widespread functional impairment: 93% experienced negative effects on physical health/activities and social relationships, 91.7% on work/school impairment, and 73.3% on family responsibility impairment. When prioritizing improvement areas, patients identified daily roles/responsibilities (66.7%), physical health/activities (66.7%), and family life/responsibilities (60.0%) as their top three prioritized functional domains. Clinicians identified work/school (100%) and family life/responsibilities (100%) as the highest prioritized domains for which patients seek improvement. Although 40.0% of patients included work/school in their top three priorities, it was the most frequently selected first-choice area for improvement.
Conclusion: These findings highlight the importance in targeting functional and cognitive domains in MDD beyond mood symptoms alone. Patients and clinicians both prioritized improvements in work/school and daily roles/responsibilities, with patients also emphasizing physical health/activities. Addressing these priorities may better meet patient needs.
