Abstract
OBJECTIVE: To understand patient factors that may affect the probability of receiving appropriate depression treatment, we examined treatment preferences and their predictors among depressed primary care patients.
DESIGN: Patient questionnaires and interviews.
SETTING: Forty-six primary care clinics in 7 geographic regions of the United States.
PARTICIPANTS: One thousand one hundred eighty-seven English-and Spanish-speaking primary care patients with current depressive symptoms.
MEASUREMENTS AND MAIN RESULTS: Depressive symptoms and diagnoses were determined by the Composite International Diagnostic Interview (CIDI) and the Center for Epidemiological Studies Depression Scale (CES-D). Treatment preferences and characteristics were assessed using a self-administered questionnaire and a telephone interview. Nine hundred eight-one (83%) patients desired treatment for depression. Those who preferred treatment were wealthier (odds ratio [OR], 3.7; 95% confidence interval [95% CI], 1.8 to 7.9; P=.001) and had greater knowledge about antidepressant medication (OR, 2.6; 95% CI, 1.6 to 4.4; P≤.001) than those who did not want treatment. A majority (67%, n=660) of those preferring treatment preferred counseling, with African Americans (OR, 2.2; 95% CI, 1.0 to 4.8, P=.04 compared to whites) and those with greater knowledge about counseling (OR, 2.1; 95% CI, 1.6 to 2.7, P≤.001) more likely to choose counseling. Three hundred twelve (47%) of the 660 desiring counseling preferred group over individual counseling. Depression severity was only a predictor of preference among those already in treatment.
CONCLUSIONS: Despite low rates of treatment for depression, most depressed primary care patients desire treatment, especially counseling. Preferences for depression treatment vary by ethnicity, gender, income, and knowledge about treatments.
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References
Wells KB, Stewart AL, Hays RD, et al. The functioning and wellbeing of depressed patients: Results from the Medical Outcomes Study. JAMA. 1989; 262:914–49.
Katon W, Schulberg H. Epidemiology of depression in primary care. Gen Hosp Psychiatry. 1992;14:237–47.
Wells KB, Golding J, Burnam MA. Psychiatric disorder and limitations in physical functioning in a sample of the Los Angeles general population. Am J Psychiatry. 1988;145:712–7.
Murray CJ, Lopez AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Disease, Injuries, and Risk Factors in 1990 and Projected to 2020. Boston, Mass: The Harvard School of Public Health; 1996.
Wells KB, Sturm R, Sherbourne CD, Meredith LS. Caring for Depression. Cambridge, Mass: Harvard University Press; 1996.
Rost K, Zhang M, Fortney J, Smith J, Coyne J, Smith GR Jr. Persistently poor outcomes of undetected major depression in primary care. Gen Hosp Psychiatry. 1988;20:12–20.
Katon W, VonKorff M, Lin E, Bush T, Ormel J. Adequacy of duration of antidepressant treatment in primary care. Med Care. 1992;30:67–76.
Clinical Practice Guideline Number 5: Depression in Primary Care, 2: Treatment of Major Depression. Rockville, Md: Agency for Health Care Policy and Research: US Dept of Health and Human Services; 1993. AHCPR publication 93-0551.
Brody DS, Khaliq AA, Thompson TL 2nd. Patients’ perspectives on the management of emotional distress in primary care settings. J Gen Intern Med. 1997;12:403–6.
Cooper-Patrick L, Powe NR, Jenckes MW, Gonzales JJ, Levine DM, Ford DE. Identification of patient attitudes and preferences regarding treatment of depression. J Gen Intern Med. 1997;12:431–8.
Eisenthal S, Emery R, Lazare A, Udin H. Adherence and the negotiated approach to patienthood. Arch Gen Psychiatry. 1979;6:393–8.
Schulberg HC, Madonia MJ, Block MR, et al. Major depression in primary care practice, Clinical characteristics and treatment implications. Pyschosomatics. 1995;36:129–37.
Schulberg HC, Magruder KM, DeGruy F. Major depression in primary care practice, Research trends and future priorities. Gen Hosp Psychiatry. 1996;18:395–406.
McKeon P, Carrick S. Public attitudes to depression: a national survey. Ir J Psycholog Med. 1991;8:116–21.
Angermeyer MC, Matschinger H. Public attitude towards psychiatric treatment. Acta Psychiatr Scand. 1996;94:326–36.
Wells KB. The design of Partners in Care: evaluating the cost-effectiveness of improving care for depression in primary care. Soc Psychiatry Psychiatr Epidemiol. 1999;34:20–9.
World Health Organization. Composite International Diagnostic Interview (CIDI) Core Version 2.1 Interviewer’s Manual. Geneva, Switzerland: World Health Organization; 1997.
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10.
Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. conceptual framework and item selection. Med Care. 1992;30:473–83.
Graubar BI, Korn EL. Predictive margins with survey data. Biometrics. 1999;55:652–9.
Marcus SC, Olfson M, Pincus HA, Shear MK, Zarin DA. Self-reported anxiety, general medical conditions, and disability bed days. Am J Psychiatry. 1997;154:1766–8.
Klerman GL, Weissman MM, Oullette R, et al. Panic attacks in the community. Social morbidity and health care utilization. JAMA. 1991;265:742–6.
Katon W, Von Korff M, Lin E, et al. Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry. 1990;12:355–62.
Wells KB, Sherbourne C, Schoenbaum M, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA. 2000;283:212–20.
Haidet P, Hamel MB, Davis RB, et al. Outcomes, preferences for resuscitation, and physician-patient communication among patients with metastatic colorectal cancer. SUPPORT Investigators. Study of Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Am J Med. 1998;105:222–9.
Brody DS, Miller SM, Lerman CE, Smith DG, Caputo GC. Patient perception of involvement in medical care: relationship to illness attitudes and outcomes. J Gen Intern Med. 1989;4:506–11.
Chwalow AJ, Mamon J, Crosby E, et al. Effectiveness of a hospital-based cooperative care model on patients’ functional status and utilization. Patient Educ Couns. 1990;15:17–28.
Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJ. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.
Katon W. The impact of major depression on chronic medical illness. Gen Hosp Psychiatry. 1996;18:215–9.
Unützer J, Patrick DL, Diehr P, Simon G, Grembowski D, Katon W. Quality adjusted life years in older adults with depressive symptoms and chronic medical disorders. Int Psychogeriatr. 2000;12:15–33.
Simon GE, Von Korff M, Barlow W. Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry. 1995;52:850–6.
Callahan CM, Hui SL, Nienaber NA, Musick BS, Tierney WM. Longitudinal study of depression and health services use among elderly primary care patients. J Am Geriatr Soc. 1994;42:833–8.
Katon W, Von Korff M, Lin E, et al. A randomized trial of stepped collaborative care for primary care patients with persistent symptoms of depression. Arch Gen Psychiatry. 1999;56:1109–15.
Katon W, Von Korff M, Lin E, et al. Population-based care of depression: effective disease management strategies to decrease prevalence. Gen Hosp Psychiatry. 1997;19:169–78.
Brody DS, Thompson TL 2nd, Larson DB, Ford DE, Katon WJ, Magruder KM. Strategies for counseling depressed patients by primary care physicians. J Gen Intern Med. 1994;9:569–75.
Catalan J, Gath DH, Anastasiades P, Bond SA, Day A, Hall, L. Evaluation of a brief psychological treatment for emotional disorders in primary care. Psychol Med. 1991;21:1013–8.
Klerman GL, Budman S, Berwick D, et al. Efficacy of a brief psychosocial intervention for symptoms of stress and distress among patients in primary care. Med Care. 1987;25:1078–88.
Teri L, Lewinsohn PM. Individual and group treatment of unipolar depression: comparison of treatment outcome and identification of predictors of successful treatment outcome. Behav Therapy. 1986;17:215–28.
Cooper-Patrick L, Gonzales JJ, Rost KM, Meredith LS, Rubenstein LV, Ford DE. Patient preferences for treatment of depression. Int J Psychiatry Med. 1998;28:382–3.
Swartz MS, Wagner HR, Swanson JW, Burns BJ, George LK, Padgett DK. Comparing use of public and private mental health services: the enduring barriers of race and age. Community Ment Health J. 1998;34:133–44.
Katon W, Von Korff M, Lin E, et al. Collaborative management to achieve treatment guidelines: impact on depression in primary care. JAMA. 1995;273:1026–31.
Lyness JM, King DA, Cox C, Yoediono Z, Caine ED. The importance of subsyndromal depression in older primary care patients: prevalence and associated functional disability. J Am Geriatr Soc. 1999;47:647–52.
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Salary support for Dr. Dwight-Johnson from NIMH grant K 12 MH00990-01-01, Partners in Care study funded by Agency for Health Care Policy and Research grant HS08349-02.
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Dwight-Johnson, M., Sherbourne, C.D., Liao, D. et al. Treatment preferences among depressed primary care patients. J GEN INTERN MED 15, 527–534 (2000). https://doi.org/10.1046/j.1525-1497.2000.08035.x
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DOI: https://doi.org/10.1046/j.1525-1497.2000.08035.x