Forks in the road: Definitions of response, remission, recovery, and other dichotomized outcomes in randomized controlled trials for adolescent depression. A scoping review

Background Definitions of dichotomous outcome terms, such as response, remission, and recovery are central to the design, interpretation, and clinical application of randomized controlled trials of adolescent depression interventions. Accordingly, this scoping review was conducted to document how these terms have been defined and justified in clinical trials. Method Bibliographic databases MEDLINE, Embase, APA PsycInfo, and CINAHL were searched from inception to February 2020 for randomized controlled trials evaluating treatments for adolescent depression. Ninety-eight trials were included for data extraction and analysis. Results Assessment of outcome measurement instruments, metric strategies, methods of aggregation, and measurement timing, yielded 53 unique outcome definitions of response across 45 trials that assessed response, 47 unique definitions of remission in 29 trials that assessed remission, and 19 unique definitions of recovery across 11 trials that assessed recovery. A minority of trials (N = 35) provided a rationale for dichotomous outcomes definitions, often by citing other studies that used a similar definition (N = 11). No rationale included input from youth or families with lived experience. Conclusion Our review revealed that definitions of response, remission, recovery, and related terms are highly variable, lack clear rationales, and are not informed by key stakeholder input. These limitations impair pooling of trial results and the incorporation of trial findings into pragmatic treatment decisions in clinical practice. Systematic approaches to establishing outcome definitions are needed to enhance the impact of trials examining adolescent depression treatment.

Automated summary

This scoping review investigated how dichotomous outcome terms such as response, remission, and recovery are defined and justified in randomized controlled trials of adolescent depression interventions. The review revealed a high variability in definitions, a lack of clear rationales, and a lack of input from key stakeholders, which can impact the pooling of trial results and the application of findings in clinical practice. Systematic approaches to establishing outcome definitions are necessary to improve the impact of trials examining adolescent depression treatment.