title: Depressive symptoms and decision-making preferences in patients with comorbid illnesses.
abstract: Shared decision-making (SDM) is increasingly promoted in the primary care setting, but depressive symptoms, which are associated with cognitive changes, may influence decision-making preferences. We sought to assess whether elevated depressive symptoms are associated with decision-making preference in patients with comorbid chronic illness.
  
  
  
  We enrolled 195 patients ≥18years old with uncontrolled hypertension from two urban, academic primary care clinics. Depressive symptoms were assessed using the 8-item Patient Health Questionnaire. Clinician-directed decision-making preference was assessed according to the Control Preference Scale. The impact of depressive symptoms on decision-making preference was assessed using generalized linear mixed models adjusted for age, gender, race, ethnicity, education, Medicaid status, Charlson Comorbidity Index, partner status, and clustering within clinicians.
  
  
  
  The mean age was 64.2years; 72% were women, 77% Hispanic, 38% Black, and 33% had elevated depressive symptoms. Overall, 35% of patients preferred clinician-directed decision-making, 19% mostly clinician-directed, 39% shared, and 7% some or little clinician-input. Patients with (vs. without) elevated depressive symptoms were more likely to prefer clinician-directed decision-making (46% versus 29%; p=0.02; AOR 2.51, 95% CI 1.30-4.85, p=0.005). Remitted depressive symptoms (vs. never depressed) were not associated with preference.
  
  
  
  Elevated depressive symptoms are associated with preference for clinician-directed decision-making. We suggest that clinicians should be aware of this effect when incorporating preference into their communication styles and take an active role in eliciting patient values and exchanging information about treatment choice, all important components of shared decision-making, particularly when patients are depressed.
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Moise
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States.
authors.forename: Siqin
authors.initials: S
authors.lastname: Ye
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States; Columbia University School of Social Work, New York, NY, United States.
authors.forename: Carmela
authors.initials: C
authors.lastname: Alcántara
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States; Department of Psychiatry, Columbia University Medical Center, New York, NY, United States.
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States. Electronic address: ik2293@cumc.columbia.edu.
authors.forename: Ian
authors.initials: I
authors.lastname: Kronish
mesh_terms: D002908:Chronic Disease / Q000523:psychology; D003142:Communication; D015897:Comorbidity; D003657:Decision Making; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D011320:Primary Health Care
keywords: Depressive symptoms; Hypertension; Shared decision-making