Symptom remission has been traditionally used as the outcome measure for remission in mental health disorders. This is how remission is defined in clinical trials. But is that what patients actually perceive as remission or what they want from treatment?
When this has been assessed further, patients indicate 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. These factors that assess quality of life and level of function are not traditionally included in the definition of remission in clinical trials. 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.
Positive mental health is defined as being:
- having self-confidence
- enjoying relationships
- having a more positive outlook on life
- functioning as well as ever
- feeling like a good person
Patients who feel as though they are in “remission” have better quality of life, less functional impairment, better positive mental health, and, important to note, lower relapse rates.
In studies that assess alternative outcome measures, patients say that non-symptoms 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. Therefore there is a premorbid protective factor for these areas of assessment as well.
It will be incomplete to talk about positive mental health without making a mention of resilience. Resilience is often discussed as the aspect of mental health and coping which is paramount to the ability to spring back during adverse circumstances. The mention of positive health necessarily recounts on the ability to withstand and cope with stress adaptively.
Resilience refers to overall physical and psychological health, and has been described as the ability to “bounce back” from adversity. Resilience is noted to be trainable.
For more details on the relationship of positive mental health and resilience click here.
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 symptom resolution. It is still important to assess for symptom resolution, but it might be helpful to ask questions informally related to positive mental health as well.