A nurse is caring for a client who has major depressive disorder. Which of the following findings should indicate to the nurse that the client's condition is improving?

Rationale: A. Self-doubt and indecisiveness are common symptoms of major depressive disorder. Continued presence of these feelings suggests ongoing impaired self-esteem and cognitive distortion, not improvement. B. Improvement in depression is often shown when the client begins to express a broader range of emotions, including anger. In severe depression, affect may be blunted or flat, and emotions may be suppressed. As recovery begins, the client regains emotional responsiveness and the ability to identify and verbalize feelings appropriately, which indicates progress in emotional processing and coping. C. Avoidance of eye contact and downward gaze are signs of low self-esteem, withdrawal, and depressive affect. These behaviors indicate ongoing depression rather than improvement. D. Flat affect is a hallmark symptom of severe depression and indicates reduced emotional expression. Improvement would be reflected by increased range and responsiveness of affect, not continued blunting.