Emotional blunting in patients with depression. Part IV: differences between patient and physician perceptions

Patient demographics

A total of 752 patients and 383 HCPs (including 226 psychiatrists and 157 primary care physicians) completed the survey. HCPs provided data for a total of 766 patients. Baseline characteristics for the two patient cohorts are shown in Table 1. Sociodemographic characteristics were similar in the two patient cohorts. However, the mean duration of depression was longer in the patient-reported cohort than in the HCP-assessed cohort (62.4 vs 46.5 months). The proportion of patients who had experienced depression for more than 5 years was also higher in the patient-reported cohort (50% vs 19% in the HCP-assessed cohort). The proportion of patients reporting past or present drug or alcohol abuse in the patient-reported cohort was approximately double that reported in the HCP-assessed cohort, both overall and for each phase of depression. In both cohorts, most patients were currently receiving treatment with an SSRI or SNRI.

Table 1 Patient demographics and baseline characteristicsSymptoms and severity

In the acute phase of depression, the prevalence of anxiety and cognitive symptoms was higher in the patient-reported cohort than in the HCP-assessed cohort (95% vs 80%, respectively, for anxiety symptoms and 73% vs 62%, respectively, for cognitive symptoms). The prevalence of mood and physical symptoms in the acute phase of depression was broadly similar in the two cohorts (Fig. 1). In the remission phase, the prevalence of all symptom types was markedly higher in the patient-reported cohort than in the HCP-assessed cohort (Fig. 1).

Fig. 1figure 1

Symptoms reported by domain and phase of depression in the two patient cohorts. p < 0.01 for all differences between the acute and remission phases within each cohort. HCP, healthcare provider

In the acute phase of depression, the prevalence of all individual symptoms was also higher in the patient-reported cohort than in the HCP-assessed cohort, and these differences were even more marked in the remission phase of the disease (Fig. 2). Irrespective of the phase of depression, anxiety was the most frequently experienced symptom (reported by 95% of patients in the acute phase of depression and 83% of those in remission; corresponding rates in the HCP-assessed cohort were 80% and 48%). Other frequently reported symptoms in both cohorts were mood symptoms, disturbed sleep, fatigue/lack of energy, and low motivation in both phases of depression. Lack of interest (i.e., anhedonia) was reported by 77% of patients in the acute phase and 52% of those in remission; corresponding rates in the HCP-assessed cohort were 67% and 22%.

Fig. 2figure 2

Individual symptoms reported in the two patient cohorts according to phase of depression. p < 0.01 for all differences between the acute and remission phases within each cohort. HCP, healthcare provider

Per protocol, all patients in the patient-reported cohort had experienced emotional blunting within the past 6 weeks. In the HCP-assessed cohort, 23% of patients were reported to have experienced emotional blunting (32% of patients in the acute phase of depression and 14% of those in remission). Patients were significantly more likely than HCPs to report extremely severe emotional blunting (a score of 6 or 7 for emotional blunting was reported for 44% vs 26% of patients in the two cohorts, respectively; p < 0.01). Differences in the prevalence of extremely severe emotional blunting between the patient-reported and HCP-assessed cohorts were most apparent during the acute phase of depression (72% vs 30% in the two cohorts, respectively; p < 0.01) (Fig. 3).

Fig. 3figure 3

Severity of emotional blunting in the two patient cohorts according to phase of depression. **p < 0.01 for patient-reported vs HCP-assessed cohort within phase of depression. Patient-reported cohort: acute phase, n = 300; remission phase, n = 452. HCP-assessed cohort: acute phase, n = 122; remission phase; n = 52. HCP, healthcare provider

Irrespective of the phase of depression, most respondents in both cohorts considered depression to be the main cause of emotional blunting (Fig. 4). In the acute phase of depression, 62% of patients and 88% of HCPs indicated that they considered depression to be the main cause of their/the patient’s emotional blunting (difference, p < 0.01). In the remission phase, depression was perceived to be the main cause of emotional blunting in 52% and 62% of patients in the two cohorts, respectively.

Fig. 4figure 4

Perceived cause of emotional blunting in the two patient cohorts according to phase of depression. **p < 0.01 for patient-reported vs HCP-assessed cohort within phase of depression. Patient-reported cohort: acute, n = 300; remission, n = 452. HCP-assessed cohort: acute, n = 122; remission; n = 52. HCP, healthcare provider

ODQ and FAST questionnaire findings

Mean (SD) ODQ ‘antidepressant as cause’ domain scores were significantly higher in the patient-reported cohort than in the HCP-assessed cohort in both the acute phase (18.0 [6.4] vs 12.5 [5.3], respectively; p < 0.01) and the remission phase (17.6 [5.9] vs 12.6 [5.9], respectively; p < 0.01). In the patient-reported cohort, 45% of patients believed that their antidepressant medication was negatively affecting their emotions, while the antidepressant was considered responsible for emotional blunting in 30% of patients in the HCP-assessed cohort (Table 2). In all, 39% of patients indicated that they were considering stopping or had stopped their antidepressant due to its perceived emotion-related side effects, while HCPs believed only 18% of patients were considering stopping their medication due to potential emotion-related side effects.

Table 2 Patient and healthcare provider net agreement with the items of the ‘antidepressant as cause’ domain of the Oxford Depression Questionnaire

The mean FAST total score was significantly higher in the patient-reported cohort than in the HCP-assessed cohort in both the acute and remission phases (p < 0.01 for both disease phases). Mean (SD) FAST total scores in the acute phase of depression were 47.0 (15.8) points in the patient-reported cohort and 39.1 (15.8) points in the HCP-assessed cohort. Mean (SD) FAST scores in the remission phase were 33.5 (16.1) points versus 19.4 (16.0) points in the two cohorts, respectively. In both cohorts, greatest impairment was seen in the ‘interpersonal relationships’, ‘cognitive functioning’, and ‘occupational functioning’ FAST domains.

Impact on functioning and quality of life

A significantly higher proportion of patients than HCPs reported a significant impact of emotional blunting on all aspects of daily functioning (work, home/family, and social life) and overall quality of life in the acute phase of depression (Fig. 5A). The proportion of patients in the acute phase of depression who experienced a significant impact of emotional blunting on functioning and overall quality of life ranged from 60 to 66% across items in the patient-reported cohort, and from 34 to 43% across items in the HCP-assessed cohort (all differences between the two cohorts, p < 0.01). In the remission phase of depression, the proportion of patients experiencing a significant impact of emotional blunting on functioning and overall quality of life was similar in the two cohorts (ranging from 29 to 37% in the patient-reported cohort and from 33 to 40% in the HCP-assessed cohort).

Fig. 5figure 5

Proportion of patients experiencing a significant impact (i.e., score of 6 or 7 on a scale of 1–7) on functioning and overall quality of life for A emotional blunting and B anhedonia according to phase of depression. *p < 0.05, **p < 0.01 for patient-reported vs HCP-assessed cohort within phase of depression. Emotional blunting — patient-reported cohort: acute, n = 300; remission, n = 452. HCP-assessed cohort: acute, n = 122; remission: n = 52. Anhedonia (i.e., patients experiencing lack of interest or pleasure in activities) — patient-reported cohort: acute, n = 231; remission, n = 236. HCP-assessed cohort: acute, n = 255; remission: n = 83.  HCP, healthcare provider; QoL, quality of life

For anhedonia (Fig. 5B), the proportion of patients in the acute phase of depression experiencing a significant impact on functioning and overall quality of life ranged from 68 to 77% in the patient-reported cohort and from 47 to 57% in the HCP-assessed cohort (all differences between the two cohorts, p < 0.01). In the remission phase, the proportion of patients experiencing a significant impact of anhedonia on functioning and overall quality of life ranged from 36 to 53% in the patient-reported cohort and from 30 to 36% in the HCP-assessed cohort (difference between cohorts, p < 0.05 for social functioning and p < 0.01 for overall quality of life).

For all other symptom domains, the proportion of patients reported to be experiencing a significant impact on functioning and overall quality of life was consistently lower in the HCP-assessed cohort than in the patient-reported cohort in both the acute and remission phases of depression (Additional file 1: Table S1). For mood symptoms, respective proportions of patients reported to be experiencing a significant impact on functioning and overall quality of life in the patient-reported and HCP-assessed cohorts ranged from 63 to 75% and from 47 to 60% in the acute phase of depression (all differences between the two cohorts, p < 0.01), and from 31 to 50% and from 24 to 30% in the remission phase (p < 0.05 for impact on home/family life, social life, and overall quality of life). Respective proportions of patients in the two cohorts reported to be experiencing a significant impact of cognitive symptoms on functioning and overall quality of life were 61–72% versus 35–54% in the acute phase (p < 0.01 for impact on home/family life, social life, and overall quality of life), and 33–42% versus 21–29% in the remission phase (p < 0.05 for home/family life and p < 0.01 for social life and overall quality of life). For fatigue/lack of energy, a significant impact of symptoms on functioning and overall quality of life was reported in 67–75% versus 43–54% of patients in the acute phase of depression (all differences between the two cohorts, p < 0.01), and 42–53% versus 23–30% of patients in the remission phase in the patient- and HCP-reported cohorts, respectively (all differences between the two cohorts, p < 0.01).

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