National Survey of Decision-Making for Antidepressants and Educational Level

Abstract

Background: Despite recommendations to screen adults for depression in primary care, little is known about how people across education levels decide to treat their depression and factors that influence their decision. Methods: We conducted a secondary analysis of a national, probability-based web survey in Englishspeaking adults aged 40 or older living in the United States who reported they discussed starting or continuing an antidepressant with their clinician in the past 2 years. Respondents answered questions about knowledge, decision-making process, and demographics. Education level was analyzed using 5 ordered categories. The Shared Decision Making (SDM) Process score was used to assess patient involvement. Descriptive statistics, 2 tests, analysis of variance, and regression models were used to describe the data and test associations. Results: Of the 5682 people invited, 3396 answered questions about health decisions (59.8% response rate) and 385 reported discussing antidepressants. The mean percentage of knowledge questions answered correctly increased as education level increased (P ‫؍‬ .008). The mean SDM Process score also increased with education (P ‫؍‬ .001). There was an association between education and who made the treatment decision, suggesting that for respondents with less education, the clinician was more likely to decide (P ‫؍‬ .001). Respondents with less education were less likely to report they would definitely make the same decision again (P ‫؍‬ .000). Conclusions: Those with less education were even less informed, had lower SDM Process scores and were less likely to think they made the right decision about antidepressants. There is a need to ensure patients are better informed about and involved in treatment for depression. (J Am Board Fam Med 2020;33:80-90.

Psychometric evaluation of a decision quality instrument for medication decisions for treatment of depression symptoms

“…Effective shared decision making requires asking patients what they prefer. The SDM Process scores were fairly low compared to other conditions [ 12 , 20 ], but were similar to previously published SDM Process scores for depression treatment [ 13 ]. The patient responses on the individual items in the SDM Process scale revealed that 265 (80.8%) discussed options, 66 (20.1%) discussed pros (a lot or some), 28 (8.5%) discussed cons (a lot or some), and 228 (69.5%) were asked their preference; this is similar to how treatment decisions are discussed and framed [ 12 ].…”

“…Also, patients who reported receiving the DA may have different knowledge than those who received and reviewed the DA. Whether or not patients received a DA, there is still a significant knowledge deficit for patients in the sample, which is similar to a national study that found patients had inadequate knowledge about depression treatment [ 13 ].…”

“…Data from past national surveys indicates that people with depression are not informed about depression or its treatments [ 10 – 12 ]. Patients with depression who had less formal education were less informed, less involved in the decision making process and less likely to report they would make the same decision again [ 13 ]. When treatment decisions between patients and clinicians are not shared, patients are more likely to receive treatment that does not match their values [ 14 ].…”

Development and Pilot Usefulness Testing of an Interactive Computerized Patient Decision Aid for Intraocular Lens Selection Before Cataract Surgery

“…4 Our results show that the education level of patients may influence their self-efficacy and preparedness for decisionmaking. Although a lower education level has been reported to be associated with lower scores of involvements in shared decision-making, 20 education level alone cannot reflect the patient's capacity to obtain, process, and understand basic health information and services, ie, health literacy. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended.…”

Family Medicine and the “New” Opioid Epidemic

“…The team lead by Purkable 13 conducted an intervention to promote discussions of quality of life goals. The associations between education level, depression care, and shared decision making is explored in the article by Brodney et al 14…”