What outcomes matter in recovery from depression? A pilot study of young adults

"Positive" outcomes such as flourishing and personal recovery are important predictors of physical health, mental illness, quality of life, and all-cause mortality. However, behavioral health outcome measures often emphasize symptom reduction, while overlooking "positive" outcomes. The objective of this study is to describe (1) the outcomes most important to individuals with major depressive disorder (MDD) and (2) "positive" outcomes and psychiatric symptoms in a real-world sample of young adults with MDD.

Forty-three participants aged 18-35 with a diagnosis of MDD receiving outpatient behavioral health treatment in an urban safety-net psychiatry department completed online surveys identifying factors most important to recovery and standardized measures of flourishing, personal recovery, functioning, and symptoms of depression and anxiety.

Most participants (61.9%) had high symptoms of depression (Patient Health Questionnaire-8 (PHQ-8) ≥ 10), 16.7% were flourishing (Flourishing Scale ≥ 48), and 41.9% had high personal recovery (Brief INSPIRE-O ≥ 50). Factors ranked as "most important" for personal recovery included coping well with stressful events (39.5%), functioning well (34.9%), and having hopes and dreams for the future (30.2%). Notably, among individuals with low depressive symptoms, 60.0% reported low flourishing and 31.3% reported low personal recovery.

Individuals with MDD value a diverse range of outcomes, and exhibit a large variation in levels of depressive symptoms and characteristics of "positive" mental health. Aligning outcome tracking with patient-defined goals may provide a more comprehensive understanding of overall mental health.