Patients' depression treatment preferences and initiation, adherence, and outcome: a randomized primary care study.
OBJECTIVE
The authors examined the association of treatment preferences with treatment initiation, adherence, and clinical outcome among nonsenior adult and senior primary care patients with depression.


METHODS
Sixty primary care participants meeting DSM-IV criteria for major depression were randomly assigned to receive treatment congruent or incongruent with their primary stated preference. Participants received either 20 weeks of escitalopram, with monitoring by a care manager, or 12 weekly sessions of interpersonal psychotherapy followed by two monthly booster sessions. Adherence to treatment and depression severity were reassessed at weeks 4, 8, 12, and 24.


RESULTS
Participants expressed stronger preferences for psychotherapy than for antidepressant medication. Preference strength was a more sensitive measure of outcome than was congruence versus incongruence of preference with the assigned treatment. Across age groups, preference strength was significantly associated with treatment initiation and 12-week adherence rate but not with depression severity or remission.


CONCLUSIONS
A continuous measure of preference strength may be a more useful measure in clinical practice than preferences per se. Future research should focus on whether and how greater facilitation of the treatment decision-making process between patient and clinician influences clinical outcome.
Raue
Patrick J
PJ
Department of Psychiatry, Weill Cornell Medical College, Cornell University, White Plains, NY 10605, USA. praue@med.cornell.edu
Schulberg
Herbert C
HC
Heo
Moonseong
M
Klimstra
Sibel
S
Bruce
Martha L
ML
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D011613:Psychotherapy / Q000379:methods / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D000928:Antidepressive Agents