title: Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review.
abstract: OBJECTIVE
  Evidence-based practice involves the consideration of efficacy and effectiveness, clinical expertise, and patient preference in treatment selection. However, patient preference for psychiatric treatment has been understudied. The aim of this meta-analytic review was to provide an estimate of the proportion of patients preferring psychological treatment relative to medication for psychiatric disorders.
  
  
  METHODS
  A literature search was conducted using PubMed, PsycINFO, and the Cochrane Collaboration library through August 2011 for studies written in English that assessed adult patient preferences for the treatment of psychiatric disorders. The following search terms and subject headings were used in combination: patient preference, consumer preference, therapeutics, psychotherapy, drug therapy, mental disorders, depression, anxiety, insomnia, bipolar disorder, schizophrenia, substance-related disorder, eating disorder, and personality disorder. In addition, the reference sections of identified articles were examined to locate any additional articles not captured by this search.
  
  
  METHODS
  Studies that assessed preferred type of treatment and included at least 1 psychological treatment and 1 pharmacologic treatment were included. Of the 644 articles identified, 34 met criteria for inclusion.
  
  
  METHODS
  Authors extracted relevant data including the proportion of participants reporting preference for psychological or pharmacologic treatment.
  
  
  RESULTS
  The proportion of adult patients preferring psychological treatment was 0.75 (95% CI, 0.69-0.80), which was significantly higher than equivalent preference (ie, higher than 0.50; P < .001). Sensitivity analyses suggested that younger patients (P = .05) and women (P < .01) were significantly more likely to choose psychological treatment. A preference for psychological treatment was consistently evident in both treatment-seeking and unselected (ie, non-treatment-seeking) samples (P < .001 for both) but was somewhat stronger for unselected samples.
  
  
  CONCLUSIONS
  Aggregation of patient preferences across diverse settings yielded a significant 3-fold preference for psychological treatment. Given evidence for enhanced outcomes among those receiving their preferred psychiatric treatment and the trends for decreasing utilization of psychotherapy, strategies to maximize the linkage of patients to preferred care are needed.
authors.affiliation: McLean Hospital, Proctor House 3 MS 222, 115 Mill St, Belmont, MA 02478, USA. kmchugh@mclean.harvard.edu
authors.forename: R Kathryn
authors.initials: RK
authors.lastname: McHugh
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Whitton
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Peckham
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Welge
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
mesh_terms: D000367:Age Factors; D002986:Clinical Trials as Topic / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy; D057240:Patient Preference / Q000523:psychology*; D011613:Psychotherapy; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D017594:Publication Bias; D012727:Sex Characteristics
chemical_list: D011619:Psychotropic Drugs