Patient Treatment Preference As a Predictor of Response and Attrition in Treatment for Chronic Depression

• Type of Material: Article
• Authors: Dana Steidtmann, Stanford University; Rachel Manber, Stanford University; Bruce A. Arnow, Stanford University; Daniel N. Klein, SUNY Stony Brook; John C. Markowitz, Columbia University; Barbara O Rothbaum, Emory University; Michael E. Thase, University of Pennsylvania; James H. Kocsis, Weill Cornell Medical College
• Language: English
• Date: 2012-10-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/da.21977
• Title of Journal or Parent Work: Depression and Anxiety
• ISSN: 1091-4269
• Volume: 29
• Issue: 10
• Start Page: 896
• End Page: 905
• Grant/Funding Information: This work was supported by NIMH grants to: Cornell University (UO1 MH62475; James H. Kocsis); University of Pittsburgh (UO1 MH61587; Michael E. Thase); Stony Brook University (UO1 MH62546; Daniel N. Klein); University of Texas Southwestern Medical Center (UO1 MH61562; Madhukar Trivedi); Emory University (UO1 MH63481; Philip Ninan and Barbara O. Rothbaum); University of Arizona (U01 MH62465; Alan J. Gelenberg); Brown University (UO1 MH61590; Martin B. Keller); Stanford University (UO1 MH61504 and 5T32MH019938-18; Alan F. Schatzberg); and Virginia Commonwealth University (U01 MH62491; James P. McCullough, Jr.). All medications for this study were donated by Forest Laboratories, GlaxoSmithKline, Organon Pharmaceuticals Inc, Pfizer Inc, and Wyeth Pharmaceuticals.
• Keywords: TRIAL; CHRONIC FORMS; SYMPTOMATOLOGY; MAJOR DEPRESSION; Psychiatry; Social Sciences; Psychology, Clinical; PSYCHOTHERAPY; Science & Technology; treatment outcome; DISORDER; Psychology; PRIMARY-CARE; BEHAVIORAL ANALYSIS SYSTEM; Life Sciences & Biomedicine; treatment engagement
• Research Categories: Psychology, Behavioral; Psychology, Clinical

Abstract

Background Findings regarding the relationship between patient treatment preference and treatment outcome are mixed. This is a secondary data analysis investigating the relationship between treatment preference, and symptom outcome and attrition in a large two-phase depression treatment trial. Methods Patients met DSM-IV criteria for chronic forms of depression. Phase I was a 12-week, nonrandomized, open-label trial in which all participants (n = 785) received antidepressant medication(s) (ADM). Phase I nonremitters were randomized to Phase II, in which they received 12 weeks of either cognitive-behavioral system of psychotherapy (CBASP) + ADM (n = 193), brief supportive psychotherapy (BSP) + ADM (n = 187), or ADM only (n = 93). Participants indicated their treatment preference (medication only, combined treatment or no preference) at study entry. Symptoms were measured at 2-week intervals with the 24-item Hamilton Rating Scale for Depression (HAM-D). Results A large majority of patients reported a preference for combined treatment. Patients who preferred medication only were more likely to endorse a chemical imbalance explanation for depression, whereas those desiring combined treatment were more likely to attribute their depression to stressful experiences. In Phase I, patients who expressed no treatment preference showed greater rates of HAM-D symptom reduction than those with any preference, and patients with a preference for medication showed higher attrition than those preferring combined treatment. In Phase II, baseline treatment preference was not associated with symptom reduction or attrition. Conclusions Treatment preferences may moderate treatment response and attrition in unexpected ways. Research identifying factors associated with differing preferences may enable improved treatment retention and response.