The interplay between mental health and mental illness in the daily experience of persons with major depressive disorder in remission: A real-time sampling study

Background: Individuals with major depressive disorder (MDD) typically present subclinical symptoms even during remission. Evidence from the Dual Continua Model (DCM), the recent view of mental health as a dynamic balance condition, and the emphasis on the role of internal and external challenges and resources in sustaining or hindering mental health suggest that the joint investigation of positive mental health (PMH) and mental illness among persons with MDD in remission provides a comprehensive assessment of both lingering symptomatology and daily functioning. Through this integrated framework the time-budget and associated experience of persons with MDD in remission were investigated. Methods: 67 clinically stable participants (Mage = 48.7) completed the Beck Depression Inventory-IIand the Mental Health Continuum-SF. Three different profiles were identified: sustainable balance (high PMH, low depression), disruptive imbalance (low/moderate PMH, high depression) and precarious balance (low/moderate PMH and low depression; high PMH and high depression). Moreover, through an Experience Sampling procedure, during one week participants provided 2067 real-time self-reports about daily activities and associated experience. Results: No group difference emerged in daily activity distribution. Multilevel regression models however revealed that, compared to the precarious balance group, the quality of experience was globally poorer in the disruptive balance group, and significantly better in the sustainable balance group. Conclusions: Within an integrative model of mental health as a condition of dynamic balance or imbalance that includes both positive mental health and clinical symptoms, findings can offer fruitful suggestions for intervention aimed at promoting daily psychosocial functioning among persons with MDD in remission.