Preferences for treatment in primary care: a comparison of nondepressive, subsyndromal and major depressive patients

doi:10.1016/j.genhosppsych.2005.10.001

General Hospital Psychiatry

Volume 28, Issue 2, March–April 2006, Pages 178-180

https://doi.org/10.1016/j.genhosppsych.2005.10.001 Get rights and content

Introduction

One of the most important patient factors that is increasingly studied is patients' preferences for treatment. As van Schaik et al. [1] showed in their review of the literature on treatment preferences, up to 66% of depressive primary care patients prefer psychotherapy or counseling, whereas treatment with antidepressant medication is preferred by only up to 38% of these patients. However, mainly patients with major depression or dysthymia have been studied [2]. Data concerning patients with subsyndromal depression are rare [3], although the relevance of this condition has been shown, especially in the primary care setting (e.g., [4]).

Comparing the methods of studies, they differ in the way the preferences for treatment are assessed. In clinical trials taking preferences into account, subjects often can only choose between psychotherapy and pharmacological treatment (e.g., [2]). This, however, is sometimes different from clinical practice, where many patients with severe depression or even with less severe forms are treated with a combination of pharmacological and psychotherapeutic treatments (e.g., [5]).

Therefore, this study aims at assessing primary care patients' preferences by giving them the possibility to choose or decline both treatment options at a time. Second, we aimed at studying if there are differences in the preferences of depressive and nondepressive primary care patients on the one hand and differences between patients with subsyndromal and major depression on the other.

Section snippets

Subjects

To identify patients with subsyndromal and major depression, we asked patients visiting their general practitioner to complete a questionnaire during their waiting time. Of 16 family practices from a medium-sized town near Heidelberg, 6 could be enlisted in the study. On predetermined days between June and November 2001, all of the patients visiting the cooperating doctors were asked to participate in our study. A sample of 607 patients with complete data for further analysis was recruited.

Measures

Results

The characteristics of the whole sample and the subgroups are presented in Table 1.

Regarding the question of which form of treatment patients would choose in case of psychological disturbances, 37.0% of the patients (n=223) preferred pharmacological treatment. Irrespective of the question concerning the preference for pharmacological treatment, 69.4% (n=418) of all the patients indicated that they would consider psychotherapy. For the combination of both treatment options, the following

Discussion

Consistent with other studies exploring the treatment preferences of primary care patients, we found that psychotherapy is clearly preferred more frequently than pharmacological treatment [1]. The analysis including all four response categories showed that only <20% of primary care patients can imagine using both therapy options and that approximately 12% refused both treatment options. Although the diagnosis of depression heightens the preference for active treatment, this result shows that

Acknowledgments

This study was supported by the medical faculty of the University of Heidelberg (Project 212/2000).

We sincerely thank the general practitioners and patients who collaborated with us in this study.

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Patients' preferences in the treatment of depressive disorder in primary care
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A comparative study of nonspecific depressive symptoms and minor depression regarding functional impairment and associated characteristics in primary care
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E. Frank et al.
Correlates of remission in primary care patients treated for minor depression
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N. Bedi et al.
Assessing effectiveness of treatment of depression in primary care: partially randomised preference trial
Br J Psychiatry
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M. Dwight-Johnson et al.
Treatment preferences among depressed primary care patients
J Gen Intern Med
(2000)

There are more references available in the full text version of this article.

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Introduction

Section snippets

Subjects

Measures

Results

Discussion

Acknowledgments

Gen Hosp Psychiatry

Compr Psychiatry

Gen Hosp Psychiatry

Assessing effectiveness of treatment of depression in primary care: partially randomised preference trial

Br J Psychiatry

Treatment preferences among depressed primary care patients

J Gen Intern Med