The RDQ for Depression from Dr. Zimmerman and Colleagues

The  two videos describe Dr. Mark Zimmerman’s new scale for determining remission from depression, the Remission from Depression Questionnaire (RDQ), which he was kind enough to send me for clinical and educational use. I’m not going to reproduce the scale here, of course, because of copyright restrictions. Eli Lilly supported the study cited below about the RDQ [1]. However, just because a pharmaceutical company funded the study doesn’t mean Dr. Zimmerman is in Big Pharma’s hip pocket. I didn’t detect a drug company bias in the study, the full paper for which I have on-line access.

The scale itself is pretty long with 41 questions, which the authors admit, though they point out that patients didn’t seem to have a problem with that. It’s too long for me to use routinely with my patient population on a busy psychiatry consultation service in a large academic medical center. However, as with all Dr. Zimmerman’s work, in my opinion, it’s a step in the right direction toward honest, effective, patient-centered care.

The  RDQ has questions about life satisfaction, coping ability, functioning, general sense of well-being, and what’s called “Positive Mental Health” (like having a positive outlook on life, making decisions without a lot of self-doubt, ability to have fun, etc.). Patients like the scale probably because it asks them about what matters most to them about recovery from depression, not just symptoms.

We need more of that from psychiatry.

1. Zimmerman, M., et al. (2013). “A new type of scale for determining remission from depression: The Remission from Depression Questionnaire.” Journal of Psychiatric Research 47(1): 78-82.
Current standards for treating major depressive disorder (MDD) recommend that achieving remission should be considered the principal goal of treatment. Recent research suggests that the symptom-based definitions of remission used in efficacy studies do not adequately reflect the perspective of depressed patients receiving treatment in routine clinical settings. We developed the Remission from Depression Questionnaire (RDQ) to capture the broader array of domains considered by patients to be relevant to the construct of remission—symptoms of depression, nondepressive symptoms, features of positive mental health, coping ability, functioning, life satisfaction and a general sense of well-being. The current report is the first study of the reliability and validity of the RDQ. The test–retest reliability of the RDQ was studied in 60 depressed outpatients in ongoing treatment. The convergent and discriminant validity of the RDQ was studied in 274 depressed outpatients who were rated on the 17-item Hamilton Depression Scale (HAM-D) and who completed several self-report scales including the Quick Inventory of Depressive Symptomatology (QIDS). The RDQ demonstrated excellent internal consistency, with a Cronbach’s α of .97 for the total scale and above .80 for each of the 7 subscales. The test–retest reliability of the total scale was .85 and above .60 for each subscale. Both the RDQ and QIDS were significantly associated with patients’ self-reported remission status. However, the RDQ remained significantly associated with remission status after controlling for QIDS scores (r = −.32, p < .001) whereas the QIDS was not associated with remission status after controlling for RDQ scores (r = −.06). The RDQ is a reliable and valid measure that evaluates the multiple domains that depressed patients consider important in determining remission. The results are consistent with prior research suggesting that depressed patients’ perspective of remission goes beyond symptom resolution.

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