Severity as a key construct in depression

Mild, moderate, and severely depressed subgroups were operationally defined in a sample of hospitalized patients clinically diagnosed as depressed. Women were overrepresented among the severely depressed patients, but no other demographic differences among subgroups were found. Generalized anxiety and psychic disorganization were significantly more pronounced in patients who were severely depressed. Severely depressed people also reported more role-performance impairments than did those who were less seriously depressed. Among women, a secondary diagnosis of substance abuse was present significantly less often in the severely depressed. Based on self-reports at admission and 4 weeks later, marked improvement was seen only among the moderately depressed. There was not a statistically significant symptom change in the mildly depressed group; for the severely depressed, the change over time was significant but the patients remained highly symptomatic. The authors discuss the importance of the construct of severity for clinical practice, hospital policy, and future research.