How Patients with Depression and their Providers Navigate Anhedonia: An Ethnographic Evaluation of Discourse Dynamics of Psychiatrists and Primary Care Providers in Clinical Settings

Abstract: Background Anhedonia, a key symptom of major depressive disorder (MDD), impacts patients' quality of life and treatment outcomes. However, limited research exists on healthcare providers’ (HCPs’), including psychiatrists’ and primary care physicians’ (PCPs’), discussions of anhedonia during clinical consultations. The objective of this study is to explore conversations between patients and HCPs related to assessment of anhedonia symptoms in routine clinical settings. 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). While HCP and patient keyword domains overlapped in the areas of lack of energy/motivation, both psychiatrist and PCP assessment questions were often misaligned with patients’ own description of anhedonia. Conclusions "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 psychiatrists and PCPs 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 in clinical practice.Short Description: This study examines discourse dynamics between patients and healthcare providers regarding anhedonia in major depressive disorder (MDD). Analyzing 60 recorded outpatient visits, it identifies eight keyword domains associated with anhedonia discussions. Findings reveal misalignment between HCP and patient perspectives. Highlighting the rarity of direct “anhedonia” usage, the study emphasizes the importance of psychiatrists and primary care physicians in understanding and addressing anhedonia through proactive symptom identification for improved patient care.Name of Sponsoring Organization(s): Johnson & Johnson Innovative Medicine