Higher Anhedonia is Associated With Poorer Clinical and Humanistic Outcomes Among US Adults With Major Depressive Disorder

Objective: Anhedonia is a key symptom and part of the diagnostic criterion of major depressive disorder (MDD). However, the relationship between anhedonia and the clinical and humanistic burden among patients with MDD is poorly understood.
Methods: Adults diagnosed with depression were identified from the 2022 US National Health and Wellness Survey (NHWS) and were recontacted to participate in an online cross-sectional survey to collect data on anhedonia, using the Dimensional Anhedonia Rating Scale (DARS), which assesses the desire, motivation, effort, and consummatory pleasure across four domains. Multivariable analyses assessed the association of total DARS score with health-related outcomes, while controlling for age, sex, race, comorbidity burden, and insurance status. Higher total DARS scores (range: 0 to 68) indicate greater motivation, effort, and pleasure (i.e., less anhedonia).
Results: Of the 8,270 NHWS respondents with depression who met inclusion criteria, 665 completed the recontact survey (mean age=58.4, 78.3% female). Mean DARS score was 52.6 (range: 2-68, median: 55, mode: 68); greater anhedonia (lower DARS scores) was associated with greater depression severity (r = −0.31, p < 0.001). After adjustments for covariates, lower DARS scores were significantly associated with higher levels of depression and anxiety, poorer mental functioning, worse health-related quality of life, greater impairment while working, and greater non-work-related activity impairment (ps < 0.001).
Conclusions: In adults with depression, higher levels of anhedonia were associated with greater clinical and humanistic burden. These results highlight the need for efficacious treatments to help MDD patients with prominent anhedonia attain improved clinical, humanistic, and work productivity outcomes.