Treating depression in general practice: Factors affecting patients' treatment preferences
Trent Institute for Health Services Research.British Journal of General Practice (Impact Factor: 2.29). 12/2000; 50(460):905-6.
We performed a cross-sectional survey of general practice attenders to determine their preferences regarding treatment for depression and characteristics associated with such preferences. Counselling was more popular than drug therapy (antidepressants), particularly among women, those who believed antidepressants are addictive, and those who had received such treatment in the past.
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- "In the United States alone, lifetime morbid risk of major depressive disorder is 29.9% and the 12-month prevalence is estimated to be between 6.6% and 10.3% (Kessler et al. 2003Kessler et al. , 2005Kessler et al. , 2012Reeves et al. 2011). Psychological treatments for depression are effective (Cuijpers et al. 2008) and desirable to patients (Priest et al. 1996;Brody et al. 1997;Bedi et al. 2000;Churchill et al. 2000;Dwight-Johnson et al. 2000). Cognitive behavioral therapy (CBT) is the most studied psychotherapy for the treatment of depression and carries the strongest body of evidence for its effectiveness (Dobson, 1989;Butler et al. 2006;Cuijpers et al. 2013). "
ABSTRACT: Cognitive behavioral therapy (CBT) can be delivered efficaciously through various modalities, including telephone (T-CBT) and face-to-face (FtF-CBT). The purpose of this study was to explore predictors of outcome in T-CBT and FtF-CBT for depression. A total of 325 depressed participants were randomized to receive eighteen 45-min sessions of T-CBT or FtF-CBT. Depression severity was measured using the Hamilton Depression Rating Scale (HAMD) and the Patient Health Questionnaire-9 (PHQ-9). Classification and regression tree (CART) analyses were conducted with baseline participant demographics and psychological characteristics predicting depression outcomes, HAMD and PHQ-9, at end of treatment (week 18). The demographic and psychological characteristics accurately identified 85.3% and 85.0% of treatment responders and 85.7% and 85.0% of treatment non-responders on the HAMD and PHQ-9, respectively. The Coping self-efficacy (CSE) scale predicted outcome on both the HAMD and PHQ-9; those with moderate to high CSE were likely to respond with no other variable influencing that prediction. Among those with low CSE, depression severity influenced response. Social support, physical functioning, and employment emerged as predictors only for the HAMD, and sex predicted response on the PHQ-9. Treatment delivery method (i.e. telephone or face-to-face) did not impact the prediction of outcome. Findings suggest that the predictors of improved depression are similar across treatment modalities. Most importantly, a moderate to high level of CSE significantly increases the chance of responding in both T-CBT and FtF-CBT. Among patients with low CSE, those with lower depressive symptom severity are more likely to do well in treatment.
- "Given the limitations of current effective therapies, and the recent emphasis on patient-centered care , there is an increasing need for an alternative treatment for insomnia symptoms. It has been shown that patient preference for nonpharmacological treatment was over three times greater than prescription medications . Thus many would prefer a non-pharmaceutical approach if an effective one were available . "
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- "Although studies have tended to find that patients prefer psychotherapy over pharmacotherapy,46,52,56–58 many patients prefer to be seen in a primary care setting, and rates of antidepressant use have increased over the last several decades, whereas psychotherapy rates are decreasing.58,70 Increased accessibility to psychotherapeutic services, particularly in a primary care setting, may increase the likelihood of patients receiving their preferred treatment. "
ABSTRACT: Patient treatment preferences are of growing interest to researchers, clinicians, and patients. In this review, an overview of the most commonly recommended treatments for depression is provided, along with a brief review of the evidence supporting their efficacy. Studies examining the effect of patient treatment preferences on treatment course and outcome are summarized. Existing literature on what treatment options patients tend to prefer and believe to be helpful, and what factors may affect these preferences, is also reviewed. Finally, clinical implications of research findings on patient preferences for depression management are discussed. In summary, although our knowledge of the impact of patient preferences on treatment course and outcome is limited, knowing and considering those preferences may be clinically important and worthy of greater study for evidence-based practice.