Symptom remission has been traditionally used as the desired outcome measure for remission in mental health disorders clinical trials. This is not however what patients actually perceive as remission or what they want from treatment?
When this contrast has been assessed, patients indicate that what they are looking for with remission is a return to normal functioning, a return to their “normal self”, and what is known as positive mental health. But outcomes associated with our patients’ quality of life and level of function are not traditionally included in the research definition of remission.
In one study, 25% of patients still had statistically significant symptoms but reported normal functioning. Half of these patients reported they were in “remission” based on self-report. And a significant number of patients who were defined in remission based on symptom measures did not define themselves as being in remission on self-report.
For most patients the following attributes help define positive mental health and offer guidance in supporting positive outcomes:
- having self-confidence
- enjoying relationships
- having a more positive outlook on life
- functioning as well as ever
- feeling like a good person
Notwithstanding the persistence of symptoms, patients who feel that they have better quality of life, less functional impairment, better positive mental health view themselves in “remission”. These individuals, not surprisingly also have lower relapse rates.
In studies that assess alternative outcome measures, patients say that non-symptom focused measures more accurately describe their overall state than symptoms measures. Additionally, patients find non-symptom measures less burdensome to complete even though they might be longer screens.
Other studies have shown that higher baseline level of function, quality of life, and positive mental health are associated with remission at 12 weeks of treatment. All in all, the data indicates that clinical attention and support to enhance patients’ self-esteem, their sense of optimism, and their engagement with others’ in their lives are important points to address in clinical encounters.
Attending to patients’ strengths, their access to family and community support, and encouraging optimism and self-confidence is thus clearly an important clinical resource.
A focus on enhancing patients’ positive mental health is an important external factor that can enhance person’s resilience – the capacity to cope with duress and the ability to spring back during adverse circumstances.
Resilience is noted to be trainable. For more details on the relationship of positive mental health and resilience click here.
Positive Mental Health and Resilience
In summary, assessments for quality of life, level of function and positive mental health might more accurately predict a patient’s sense of remission than a limited focus just on symptom resolution.
K.Srivastava, “Positive mental health and its relationship with resilience, Ind. Psychiatry Journal, 2011 Jul-Dec: 20(2)
Luthar SS, Cicchetti D, Becker B; The construct of resilience: A critical evaluation and guidelines for future worlk. Child Dev. 2000;71:543-62