Assessment of social functioning in depression

Impairment of social functioning is a significant aspect of depression distinct from the symptoms of depression. Social functioning defines an individual's interactions with their environment and the ability to fulfill their role within such environments as work, social activities, and relationships with partners and family. The analysis of social functioning has arisen from a growing interest in measuring the consequences of depression and antidepressant therapy. Impairment often persists long after the resolution of symptoms by pharmacotherapy, and is not extensively assessed by the traditional scales to measure the intensity of depressive symptoms. Assessment is influenced by the method used, and there is an increased awareness that the patient's perspective should be foremost. Several scales for the evaluation of social functioning have already been developed, ranging from those requiring a structured interview with a trained assessor to self-assessment scales. In constructing such tools, a balance must be found between the amount of detail required to produce a clear account of the patient's social functioning and the ease of use in large multicenter studies. The newest scale is the Social Adaptation Self-evaluation Scale (SASS), specifically for self-assessment of social functioning by patients with depression. It contains 21 items covering the different aspects of social interactions, global social attitude, and self-perception. The SASS has been validated and found to be simple to use and sensitive to changes in the different areas of social functioning. Recently, the SASS was used to demonstrate the greater efficacy of reboxetine, a new selective noradrenaline reuptake inhibitor (selective NRI), compared with the selective serotonin reuptake inhibitor (SSRI) fluoxetine, in improving social functioning in patients with depression. Specifically, the SASS was able to show that reboxetine improved patient motivation and self-perception. The SASS is another tool for the evaluation of the extent and quality of the response to treatment and may also help to elucidate the roles of noradrenaline and serotonin in depressive illness.