How do Patients with Depression and their Providers talk about Anhedonia? An Ethnographic Analysis of Healthcare Provider Conversations with Patients in the Clinical Setting.
Background
Anhedonia, a core symptom of major depressive disorder (MDD), impacts patients' quality of life and treatment outcomes. However, limited data exist on how anhedonia is discussed and identified in healthcare provider (HCP)-patient conversations within clinical settings. The purpose of this study is to uncover how patients and HCPs describe anhedonia symptoms during routine clinical consultations.
Methods
Transcripts of 60 recorded conversations during outpatient HCP-patient visits for the clinical management of MDD in community-based private practices (US only) were analyzed. Recordings were collected from 29 unique HCPs, including 10 psychiatrists and 19 PCPs.
Results
Results revealed no singular keyword for anhedonia discussion, but that 8 keyword domains were associated with discussion of anhedonia (HCP-domains: energy, social relations, interest/activity/hobby, and motivation; Patient-domains: lack of volition for generic activity, fatigue, social disconnectedness, and lack of appropriate emotion). Slightly over half of anhedonia conversations were introduced by patients, suggesting that the onus to raise the topic may fall disproportionately on patients.
Conclusions
The term "anhedonia" is seldom used directly. Instead, patients generally describe their experience with keyword domains that are frequently misaligned with those of HCPs, and which may be perceived as vague. Acknowledging this not only affords the opportunity to enhance patient-centered care but emphasizes the critical role of providers in bridging the gap between medical terminology and patient narratives. Cultivating awareness of how anhedonia is articulated and employing proactive symptom identification can prevent its oversight and enhance the detection and management of anhedonia in routine clinical practice.
