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. 2025 Feb 12;17(2):e78891.
doi: 10.7759/cureus.78891. eCollection 2025 Feb.

Understanding High-Functioning Depression in Adults

Judith F Joseph  1 , Umit Tural  2 , Nikeisha D Joseph  1 , Teresa E Mendoza  1 , Eshna Patel  1 , Rachel Reifer  1 , Margot Deregnaucourt  1
Affiliations

Understanding High-Functioning Depression in Adults

Judith F Joseph et al. Cureus. .

Abstract

Introduction: High-functioning depression (HFD) is described as experiencing depressive symptoms such as fatigue, anhedonia, poor concentration, guilt, restlessness, sleep disturbances, and appetite changes without experiencing a lack of functioning or significant distress. The purpose of this study is to characterize the clinical correlates of HFD.

Methods: This study entailed a descriptive, cross-sectional design based on interviews administered to120 English-speaking participants with HFD (aged 18-75). The interview involved administering a semi-structured HFD Analysis Questionnaire, the Joseph HFD Inventory, the HFD Trauma Inventory, and the Joseph HFD Anhedonia Scale in a single, 30-minute session for each participant. Big traumas, defined as extremely traumatic events, were analyzed by the trauma inventory.

Results: Out of the 120 participants, 72 (60%) demonstrated HFD, and 17 (14%) demonstrated very HFD. A correlation was observed between symptoms of HFD, such as anhedonia and marital status, as post hoc tests showed that the average Anhedonia Scale score was higher for married or partnered participants than those who were single (p=0.038). As anticipated, the participants with higher Anhedonia Scale scores had higher HFD scores (p=0.003). These participants also experienced higher trauma inventory scores and big traumas. Furthermore, as participant education level increased, the number of big traumas reported decreased (p<0.001). Participants who were parents/caregivers of children also had the highest Anhedonia Scale and HFD scores (p=0.0126 and p=0.0210, respectively).

Conclusion: The results supported the hypothesis that individuals with HFD have increased levels of anhedonia and trauma. However, trauma scores were inversely associated with education level in HFD.

Keywords: depression; high-functioning; high-functioning depression; major depression; major depressive disorder.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. HFD-TI scores decreased as education level increased
HFD-TI: High-Functioning Depression Trauma Inventory
Figure 2
Figure 2. Decreasing trend in the number of big traumas with increasing education levels
Figure 3
Figure 3. Psychometric scale scores showing a positive correlation between HFD and trauma. The blue line indicates the regression line with 95% confidence intervals indicated by the dark gray shaded area
HFD: high-functioning depression
Figure 4
Figure 4. Psychometric scale scores showing a positive correlation between anhedonia and HFD. The blue line indicates the regression line with 95% confidence intervals indicated by the dark gray shaded area
HFD: high-functioning depression
Figure 5
Figure 5. Correlation analyses between the HFD-TI scores and big trauma demonstrating a strong positive correlation. The blue line indicates the regression line with 95% confidence intervals indicated by the dark gray shaded area
HFD-TI: High-Functioning Depression Trauma Inventory
Figure 6
Figure 6. Density plot analyses showing higher HFD-I scores for participants with three or more big traumas (bigT3+)
HFD-I: High-Functioning Depression Inventory
See this image and copyright information in PMC

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