Treatment preferences in patients with first episode depression

Abstract

Background: Treatment preferences of patients suffering from depression may affect adherence and clinical outcomes. This study examines associations between patients' treatment preferences, their characteristics and illness representations of depression. Methods: Illness representations of depression (IPQ-R), treatment acceptability and preferences were assessed in 88 newly diagnosed patients with first episode depression. Other measures recorded: gender, age, education level, income, psychiatric comorbidity, depressive symptomatology (PHQ-9), a family history of depression, and current treatment of depression. Multiple logistic regression was used to identify factors associated with a preference for psychotherapy. Results: Psychotherapy was preferred by 41% of participants, while 31% favored antidepressants. Acceptability was strongly associated with preference. Patients preferring psychotherapy perceived that their depression has more serious consequences than those preferring medication and were more likely to attribute their depression to social causes than psychological or physical causes. Participants who preferred psychotherapy were more likely to be female, have a university degree and have a family history of depression. Limitations: The cross-sectional design precludes causal interpretations. Conclusions: Preferences vary according to gender, level of education, family history and illness representations. It may be important to provide accurate information on both treatments and discuss patients' preferences before prescribing treatment. Methods: Illness representations of depression (IPQ-R), treatment acceptability and preferences were assessed in 88 newly diagnosed patients with first episode depression. 1 Treatment preferences in patients with first episode depressionOther measures recorded: gender, age, education level, income, psychiatric comorbidity, depressive symptomatology (PHQ-9), a family history of depression, and current treatment of depression. Multiple logistic regression was used to identify factors associated with a preference for psychotherapy.Results: Psychotherapy was preferred by 41% of participants, while 31% favored antidepressants. Acceptability was strongly associated with preference. Patients preferring psychotherapy perceived that their depression has more serious consequences than those preferring medication and were more likely to attribute their depression to social causes than psychological or physical causes. Participants who preferred psychotherapy were more likely to be female, have a university degree and have a family history of depression. Limitations:The cross-sectional design precludes causal interpretations. Conclusions:Preferences vary according to gender, level of education, family history and illness representations. It may be important to provide accurate information on both treatments and discuss patients' preferences before prescribing treatment.

Predictors of response in the treatment of moderate depression

“…Participants were mostly young women with good socioeconomic level and educational attainment, who tended to adapt to psychotherapy more easily. 35 The possibility exists that other patients (i.e., older women or men and women with a lower social and education levels) might have difficulty adapting to psychotherapy or other long-term treatments. This discrepancy in adaptation to long-term treatment would reduce the external validity of our results.…”

Should treatment for depression be based more on patient preference?

“…The research on the effect of race on treatment preferences has been mixed, with some studies finding no difference in preferences,62,63 and others finding differences in the acceptability of medication and psychotherapy, with minority patients often being found to be less accepting of treatment in general, and particularly less accepting of medication 57,64,65. With regards to sex, men may be more accepting of medication than women,54,56 and women have been found to be more likely to prefer counseling 57,66. Severity of depression has been found to be associated with less positive attitudes toward antidepressants 67.…”

Use of medication and psychological counselling among Canadians with mood and/or anxiety disorders

“…While psychological counselling has been shown to have comparable effects as medication in several depressive and anxiety disorders, 43 and there is evidence to suggest that psychotherapy is generally preferred over pharmacotherapy, 44,45 findings from our study demonstrated that individuals with mood and/or anxiety disorders are more likely to be treated with medication. This could be due to a number of factors, including individuals' limited knowledge of the benefits of psychotherapy treatments, availability and access to Continued on the following page such mental health services, physicians' treatment preferences and treatmentrelated costs.…”