Great expectations: factors influencing patient expectations and doctors recommendations at a Mood Disorders Unit.
BACKGROUND
Literature about expectations and management of depression within community samples reflects attitudes of people who have generally not received treatment. We examined the factors influencing treatment expectations and psychiatrists' treatment recommendations for patients referred to a mood disorders unit with identified episodes of major depression.


METHODS
Prior to attending a mood disorders unit, 182 men and women who met DSM-III-R or DSM-IV criteria for current major depression provided data on sociodemographic details, history of medical and psychiatric illness and expectations of treatment. Psychiatrists' treatment recommendations to the referring clinician were assessed to determine whether the patients' initial expectations were met.


RESULTS
Data analyses revealed three factors relating to patients' expectations: "enhanced coping", "providing fresh ideas for the referring doctor" and "providing fresh ideas to self". Patients' expectations were influenced by sociodemographic and illness-related characteristics. In particular, young female patients typically expected to receive strategies to enhance coping, while those with lifetime anxiety expected less active involvement on their part. Some clinicians' recommendations were dependent upon depression type and patient factors. Women and those with a history of anxiety disorders received more education and recommendations for relationship counselling and support groups.


CONCLUSIONS
The study design did not allow determination of the impact of patients' expectations on the psychiatrists' recommendations.


CONCLUSIONS
Individual and illness characteristics are important predictors of treatment expectations prior to specialist care. It appears that doctors take these factors into account with implications for patients' satisfaction with the type of care recommended.
Wilhelm
Kay
K
School of Psychiatry, University of New South Wales and Mood Disorders Unit, Black Dog Institute, Sydney, Australia. kwilhelm@stvincents.com.au
Wedgwood
Lucinda
L
Malhi
Gin
G
Mitchell
Philip
P
Austin
Marie-Paule
MP
Kotze
Beth
B
Niven
Heather
H
Parker
Gordon
G
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D001294:Attitude to Health; D003376:Counseling; D003865:Major Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010361:Patients / Q000523:psychology*; D010820:Physicians; D011613:Psychotherapy
D000928:Antidepressive Agents