Shorter communicationTreatment preference, engagement, and clinical improvement in pharmacotherapy versus psychotherapy for depression
Section snippets
Participants
The University of Washington Institutional Review Board approved the protocol.1 All participants provided written informed consent prior to participation. Details regarding recruitment, eligibility criteria and screening are available elsewhere (Dimidjian
Treatment preferences
On the ETI, 51 participants (48.1%) preferred psychotherapy, 19 (17.9%) preferred ADM, and 36 (34.0%) expressed no preference.
Refusing randomization
Twelve of 106 participants (11.3%) refused randomization. Of those randomized to their non-preferred group, 7 out of 44 (15.9%) refused randomization. Five out of 36 individuals (13.9%) who expressed no preference refused randomization. No participants randomized to their preferred group refused randomization (vs. non-preferred, χ2 (N = 70, df = 1) = 4.60, p = .03; See
Discussion
This study examined the effects of patient preferences on a range of outcomes in an RCT of the treatment of major depression. Results suggest several negative implications of being randomly assigned to a non-preferred mode of treatment. Mismatch had an effect on whether patients started treatment, such that none of those who refused randomization received a preferred treatment. Similarly, those randomized to a non-preferred treatment were more likely to dropout of the study and attend fewer
Acknowledgments
This research was supported by National Institute of Mental Health Grants MH55502 (R01), and MH079636 (F31), a predoctoral fellowship awarded to Bethany Kwan. We wish to acknowledge the investigator group for the National Institute of Mental Health Grant MH55502 (R01): Bob Kohlenberg, Karen Schmaling, David Dunner, Keith Dobson, and Steve Hollon, for their willingness to make data for this report available. GlaxoSmithKline provided medications and pill placebos for the trial. Correspondence
References (32)
- et al.
The conflict between random assignment and treatment preference: implications for internal validity
Evaluation and Program Planning
(2003) - et al.
Depression treatment preferences of VA primary care patients
Psychosomatics
(2007) - et al.
The relation of patients’ treatment preferences to outcome in a randomized clinical trial
Behavior Therapy
(2007) - et al.
Impact of age, health locus of control and psychological co-morbidity on patients’ preferences for shared decision making in general practice
Patient Education and Counseling
(2006) - et al.
Research to improve the quality of care for depression: alternatives to the simple randomized clinical trial
General Hospital Psychiatry
(2003) - et al.
Cognitive therapy for depression
(1979) - et al.
Manual for the BDI-II
(1996) Cognitive therapy: Basics and beyond
(1995)- et al.
Adherence to treatment in mood disorders
Current Opinion in Psychiatry
(2006) - et al.
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression
Journal of Consulting and Clinical Psychology
(2006)