| Bedi et al (2000)29
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Psychotherapy vs pharmacotherapy:
(1) Randomized to counseling (2) Randomized to antidepressants (3) Preference counseling (4) Preference antidepressants
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323 patients recruited from general practices in the United Kingdom meeting RDC for major depression(randomized: n = 103, preference counseling: n = 140, preference antidepressants: n = 80) |
Partially randomized preference trial |
Preference for those who refused randomization was based on treatment selected. Baseline comparisons between randomized and preference patients. Outcomes for patients in randomized vs preference groups, including within-treatment–type analyses |
(1) Demographic and clinical characteristics compared at baseline (2) Depression outcome: BDI at 8-wk follow-up (3) Depression outcome: RDC at 8-wk follow-up (4) Quality of life: SF-36 at 8-wk follow-up |
(1) The only significant difference between randomized and preference patients at baseline on a wide range of demographic and clinical variables was that patients who preferred antidepressants had more severe depression at baseline as rated by their general practitioner (P < .004) (2) Depressive scores on the BDI at 8-wk follow-up were not significantly different between randomized and preference patients (counseling: P = .69; antidepressants: P = .66) (3) Depression scores on the RDC at 8-wk follow-up were not significantly different between randomized and preference groups (counseling: P = .70; antidepressants: P = .86) (4) SF-36 scores were not significantly different for within-treatment–type comparisons (P values not reported, not significant) |
| Chilvers et al (2001)30 (same sample as Bedi et al29) |
Psychotherapy vs pharmacotherapy:
(1) Psychotherapy arms included 6 counseling sessions by experienced treatment providers, and treatment approach was at the discretion of each counselor (2) Pharmacotherapy was based on written guidelines for routine drug treatment provided to general practitioners
|
323 patients recruited from general practices in the United Kingdom meeting RDC for major depression (randomized: n = 103; preference counseling: n = 140; preference antidepressants: n = 80) |
Partially randomized preference trial |
Preference for those who refused randomization was based on treatment selected Is the effectiveness of generic counseling and antidepressants different for patients with mild to moderate depression? Does treatment preference influence remission? |
(1) Depression outcome: response rate at 12 mo (2) Depression outcome: BDI score at 12 mo (3) Global outcome: rating by a blinded psychiatrist as good, moderate, poor, or unknown (4) Depression outcome: remission (score < 4 on the RDC or < 10 on the BDI or clear documentation in the practitioner's notes that the patient was well (5) Relapse: deterioration within 6 mo of remission |
(1) No significant differences in response rates at 12 mo between patients who were randomized and those who were included in the preference arm (P = .34) (2) No differences on the BDI between randomized and preference patients treated with antidepressants (P value not reported). Patients who chose counseling did (marginally) better than those randomized to counseling (95% CI, 0.0–9.2; P value not reported) (3) No difference in global outcome between randomized and preference groups (P = .63) (4) Proportion of patients with remission was similar across groups (P = .74) (5) No differences among the groups in rates of relapse (P = .46) |
| Delini-Stula et al (2009)38
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Pharmacotherapy:
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5,428 for Internet survey and an additional 3,283 for post hoc analyses including patients from Korea (total N = 8,811) 62.3% female; majority between age of 25 and 50 y Inclusion criteria: at least aged 18 y; diagnosis of MDD according to DSM-IV criteria; previously treated with conventional mirtazapine or no antidepressant Recruitment: 17 countries in Europe, Latin America, and Asia |
Global Internet survey of patient preference. Groups were determined based on the formulation that patients were prescribed by their physicians prior to the survey |
Patient preference was assessed using a survey question of preference for FDT or conventional mirtazapine Which formulation of mirtazapine do patients prefer? Is compliance different between the 2 formulations? |
|
(1) FDT formulation was preferred to conventional formulation by 62.1% of all subjects: 68% in Europe, 62.5% in Latin America, and 58.6% in Asia (2) For patients who had experienced both formulations, 41.33% had improved compliance with FDT |
| Dobscha et al (2007)42
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Models of care comparison:
(1) Collaborative intervention (consisting of 1 early patient-educational contact by a care manager, ongoing depression monitoring, and communication of depression severity scores and treatment recommendations to clinicians over 12 mo) (2) Usual care
|
|
Randomized controlled trial |
Preferences assessed at study entry. Asked patients to select 1 preferred option from antidepressants, individual counseling, group counseling, antidepressants plus counseling, or watchful waiting Identify overall treatment preferences Identify relationships between baseline characteristics and preferences Determine whether there is a relationship between preferences and treatment offered or treatment received |
(1) Baseline characteristics (2) Treatment offered: medical records review (antidepressants = prescription in computer, counseling = referral generated, watchful waiting = doctor's note indicating that patient chose not to initiate treatment) (3) Treatment received: database review (antidepressant: prescription data; counseling: mental health appointments) (4) Depression outcome: change in PHQ score (5) Patient satisfaction: measurement method not stated |
(1) Patients preferring antidepressants (alone or with therapy) had significantly more severe depression (P = .02). Patients who had worked in the previous 12 mo were more likely to prefer individual counseling (along or with antidepressants; P = .01). Patients with active PTSD were more likely to prefer antidepressants and counseling (P = .04). Patients who were taking antidepressants at study entry were significantly more likely to prefer antidepressants (P = .001) (2) Treatments offered were associated with patient preferences for all groups except for group therapy. Patients with a preference for specific treatments were more likely to be offered that treatment (P values = .001–.04) (3) Having a preference for a specific treatment was associated with being offered that treatment but not with receiving that treatment (4) There were no associations between being offered or receiving one's preferences and depression change scores (5) There were no associations between being offered or receiving a preferred treatment and patient satisfaction |
| Dwight-Johnson et al (2001)31
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Models of care comparison:
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N = 742 (mean age of 44 y; 74% female) Inclusion criteria: met criteria for probably depressive disorder (≥ 1 wk of depressed mood or loss of interest in pleasurable activities during last year or persistent depression during year plus at least 1 wk of depression in last 30 days); intended to use clinic as source of primary care for next year; had insurance that covered care from Partners in Care behavioral health care providers Recruitment: from 46 primary care clinics in the United States |
Longitudinal group-level, randomized, controlled trial of a quality improvement program in depression compared with usual care Clinics were randomized to 1 of the 3 interventions |
Treatment preferences were assessed at baseline and 6 mo by patient self-report using a question that included options for medication, individual counseling, group counseling, and “wait and see.” Each option included associated costs, side effects (where applicable), and chance of a cure. Outcomes for patients receiving quality improvement interventions were compared Do these interventions increase likelihood of patients entering depression treatment and receiving preferred treatment? |
|
(1) For patients not in treatment at baseline who preferred medication, QI-Meds was significantly better than QI-Therapy (P = .020) or usual care (P = .001) in encouraging patients to enter depression care. For those preferring therapy, both QI-Meds (P = .001) and QI-Therapy (P = .015) were more effective than usual care in encouraging patients to enter depression care (2) Patients in intervention clinics were more likely to get the treatments they preferred compared with those in usual care (P < .003) |
| Elkin et al (1999)32
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Psychotherapy vs pharmacotherapy:
(1) Cognitive-behavioral therapy (2) Interpersonal psychotherapy (3) Medication (imipramine) plus clinical management (4) Placebo plus clinical management
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Randomized, controlled collaborative (3 research sites) clinical trial Random assignment to treatment groups |
Based on responses to questions on attitudes and expectations associated with each form of treatment offered in the study Comparison of outcomes for patients who received treatment congruent vs incongruent with their stated preferences |
(1) Attrition (2) Engagement: patient perception of therapeutic conditions assessed using the Barrett-Lennard Relationship Inventory (3) Therapeutic alliance assessed using the Modified Vanderbilt Therapeutic Alliance Scale (4) Depression outcome: BDI |
(1) Incongruent group: more likely to drop out (odds ratio = 4.76; P < .05) (2) Congruence significantly predicted patients’ ratings of engagement (R2 change = 0.06; P < .05) (3) Congruent group: higher ratings of patients’ contribution to the therapeutic alliance (R2 change = 0.14; P < .01) (4) Depression severity at 4 wk was not significantly associated with congruence when baseline depression scores were included in the model (P = .32) |
| Granger et al (2006)39
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Different dosing schedules for bupropion:
(1) Bupropion sustained release (SR) once daily (2) Bupropion SR twice daily (3) Bupropion SR thrice daily
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Participants were identified through a survey research group and completed a 20-item Web-based survey |
Patients indicated interest in a once-daily formulation of bupropion by answering the question, “How interested would you be in a new form of bupropion that worked just as well as bupropion SR but that you only had to take once a day?” |
Adherence assessed by the question, “Do you always take your bupropion SR as many times per day as your doctor told you to?” |
(1) Adherence failure: 15% of once-daily users, 37% of twice-daily users, 65% of thrice-daily users (2) Twice-daily users were 6 times more likely and thrice-daily users were 28 times more likely to be interested in a daily formulation compared with current once-daily usersa |
| Gum et al (2006)43
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Models of care comparison:
(1) Mental health services (depression care manager) integrated into primary care and included medications (2) Treatment typically received in primary care clinic—could include antidepressants, referral to mental health specialist, or any other depression treatments
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1,602 depressed older (aged 60 to > 75 y, mean = 71.1 y) primary care patients Inclusion criteria: individuals met criteria for major depression or dysthymia according to DSM-IV criteria; planned to use the primary clinic for the next year; spoke English Recruitment: patients attending 18 primary care clinics from 8 health care organizations in 5 states |
Multisite, randomized, controlled clinical trial |
At baseline, patients were asked to state their preference for 1 of the 2 active treatments. Comparison of outcomes for those who had received preferred treatment vs those who had not. Receipt of preferred treatment (assessed based on self-report of care received) |
(1) Receipt of preferred treatment (2) Satisfaction with treatment (single question, Likert scale rating) (3) Depression outcome: improvement in depression (50% reduction in depression symptoms based on the 20-item SCL) |
(1) Patients who preferred counseling or antidepressants were significantly more likely to receive their preferred treatment in collaborative care (counseling: P < .0001; antidepressants: P < .001) (2) Receipt of preferred treatment did not significantly impact treatment satisfaction (P = .73) (3) At 12-mo follow-up there was no significant difference in depression outcome between those who had received preferred treatment vs those who had not (P = .79) |
| Iacoviello et al (2007)33
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Pharmacotherapy (active or placebo) vs psychotherapy(twice-weekly sessions for 4 wk, then weekly sessions for 12 wk) |
|
Randomized controlled trial |
Preference was assessed before randomization with a single question that asked patients whether they would prefer drug treatment or talking treatment Determine how congruence or incongruence of treatment preference and treatment received influence development of therapeutic alliance |
Therapeutic alliance assessed using the California Psychotherapy Alliance Scale (higher scores = greater alliance) at baseline and 3, 5, and 9 wk |
Among patients preferring psychotherapy, therapeutic alliance scores increased significantly over time for those receiving psychotherapy (P < .04), did not change significantly for those receiving medication (P = .15), but decreased significantly for those receiving placebo (P < .002). Among patients preferring pharmacotherapy, there were no differences in alliance development regardless of the treatment they received (all P values = not significant) |
| Kocsis et al (2009)34
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Psychotherapy vs pharmacotherapy:
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N = 429 Inclusion criteria: aged 18–75 y; met DSM-IV criteria for current MDD of at least 2 y duration, MDD superimposed on antecedent dysthymic disorder, or recurrent MDD with incomplete interepisode recovery with total continuous illness duration of at least 2 y HDRS-24 score ≥ 20 at screening and at baseline following 2-wk drug-free period |
Randomized trial with crossover design; groups were randomly assigned after 2-wk evaluation period; nonresponders to monotherapy were crossed over and treated with the other monotherapy |
Assessed at baseline by a single written question: asked if they preferred medication, psychotherapy, combination treatment, or had no preference; 88 had no preference, 33 preferred medications, 53 preferred psychotherapy, 255 preferred combined treatments Does patient preference impact treatment response for patients with chronic forms of MDD? |
|
(1) There was a statistically significant interaction between patient preference and outcome. Patients who received a treatment concordant with their preference were significantly more likely to achieve remission or partial response over the course of the trial (P = .039). For patients who preferred and received combination therapy, the remission rate was 39.1%. For patients who preferred monotherapy (only psychotherapy or medication) but received combination therapy, the remission rate was 42.2% (2) There were no significant differences in attrition rate for those who received their preferred treatment vs those who did not |
| Leykin et al (2007)35
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Psychotherapy vs pharmacotherapy:
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240 adults (59% female, 41% male) Inclusion criteria: met criteria for MDD according to DSM-IV criteria; HDRS score ≥ 20 on 2 assessments at least 1 wk apart Recruitment: from physician referrals and media advertisements |
Randomized, placebo-controlled clinical trial |
During the intake visit, participants were asked to state which treatment they would prefer: drug treatment, talking treatment, or no preference (treatment preference). Participants were also offered the same 3 choices but asked which treatment they expected would be the most effective (expectation preference). The 2 preference measures were highly correlated (r = 0.68) Is receipt of preferred treatment a predictor of treatment success? |
|
(1) There were no significant differences between those who were assigned to their preferred treatment and those who were not in dropouts (treatment preference: P = .51; expectation preference: P = .57) (2) At wk 16, there was no significant effect of being matched with preferred treatment on depression as measured by the HDRS (treatment preference: P = .39; expectation preference: P = .86) (3) At wk 16, there was no significant effect of being matched with preferred treatment on depression as measured by the BDI (treatment preference: P = .87; expectation preference: P = .23) |
| Lin et al (2005)36
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Methods of care comparison:
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N = 335 (mean age of 57 y; 95.5% were male; 78.8% were white Inclusion criteria: no ongoing intensive treatment for depression; must not require acute treatment for substance abuse, PTSD, or other conditions; must not have acute suicidality and psychosis Recruitment: internal medicine clinic of department of Veterans Affairs; from 2 ongoing unrelated studies, prevention survey in the clinic, and direct referral |
Randomized, controlled, longitudinal trial of depression management; patients assigned to treatment group based on location of treatment; random assignment of clinics to 1 of 2 methods of chronic illness management |
At initial screening visit, patients were asked their preference from options that included medication, counseling, both, neither, or don't know/refused Does treatment preference match have an impact on depression treatment outcome? |
|
(1) At 3-mo follow-up, patients who received their preferred treatment had significantly larger improvements in their depression scores (P < .05) (2) At 9-mo follow-up, there was no significant difference in improvements for those who received their preferred treatment vs those who did not (P = .064). These results may suggest a more rapid treatment response for those patients matched to their preferred treatment modality |
| Raue et al (2009)37
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Psychotherapy vs pharmacotherapy:
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60 primary care patients meeting DSM-IV criteria for MDD Inclusion criteria: > 21 y, meet SCID criteria for MDD, score ≥ 14 on HDRS |
Randomized controlled trial with patients receiving treatment either congruent or incongruent with their primary treatment preference |
Rank ordering of treatment options that included antidepressant medication, individual or group psychotherapy, combined medication and psychotherapy, herbal remedies, religious/spiritual activities, exercise, or “do nothing” Determine whether treatment preference is related to treatment initiation, adherence, and depression outcomes |
(1) Treatment initiation (taking 1 dose of medication or attending 1 therapy session) (2) Adherence to treatment (based on the proportion of scheduled treatments—psychotherapy adherence: care manager records; medication adherence: self-reports) (3) Depression outcomes: HDRS severity (24-item) (4) Remission |
(1) Significantly more patients who were randomly assigned to their preferred treatment initiated treatment (congruent = 100%; incongruent = 74%; P = .005). Treatment initiation was also associated with stronger preferences (P = .001) (2) Being assigned to preferred treatment was not significantly associated with treatment adherence rates at 12 wk; however, preference strength was positively associated with greater adherence (P = .002) (3) Being assigned to preferred treatment was not significantly associated with depression as measured by HDRS ratings at 12 or 24 wk. Preference strength was significantly negatively associated with depression outcomes at 12 wk, which was an unexpected finding (P = .028) (4) Treatment congruence was not associated with remission rates at 12 or 24 wk |
| Van et al (2009)40
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Short-term psychodynamic supportive psychotherapy:
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59 randomized and 60 preference patients (mean age of 35.9 y; 79.8% were female) Inclusion criteria: between age of 18 and 65 y, depressive episode with or without dysthymia (DSM-IV), 17-item HDRS score between 14 and 25 Recruitment: referred outpatients from a large psychiatric teaching hospital in Amsterdam |
Randomized trial with patient preference arm. For those willing to receive randomized therapy, block randomization stratified by age and gender was used. Those who refused randomization were given treatment of choice |
Patients refusing randomization were given their treatment of choice, only those electing psychotherapy were included in the analyses, as only 3 patients chose to start with pharmacotherapy; treatment preference was not assessed in those patients who were randomized Do dropout rates and depression outcomes vary between patients who are randomized to treatment or those who choose their treatment? |
(1) Baseline clinical and sociodemographic characteristics (2) Dropout: during first 8 wk of treatment (attended fewer than 5 therapy sessions) (3) Depression outcome: response rate (> 50% reduction on the HDRS) (4) Depression outcome: CGI-Severity of Illness and CGI-Improvement scales (5) Depression outcome: depression subscale of 90-item SCL |
(1) There was no significant difference between the randomized and preference groups for demographic and clinical characteristics (2) There was no significant difference in dropout rate during the first 8 wk between the randomized and preference groups (P = .23) (3) There was no significant difference in depression outcome (response rate) after 8 wk. No significant differences were found in the response rates from wk 8 to 24 (4) There was a significant difference on CGI-Severity of Illness scale in favor of preference group (P = .03) at 8 wk. There was no significant difference in the CGI-Improvement scale at 8 wk. No significant differences were found in the clinician ratings from wk 8 to 24 (5) There were no significant differences on the depression subscale of the 90-item SCL at 8 wk. No significant differences were found on the 90-item SCL depression subscale from wk 8 to 24 |
| Ward et al (2000)41 (Data also presented in King et al, 2000)44
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Two types of psychotherapy were compared:
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464 (mean age of 37 y; 75% were female) Inclusion criteria: at least aged 18 y; depressed or depressed and anxious assessed by a score ≥ 14 on BDI Recruitment: 73 general practices in London and greater Manchester; general practitioners referred all patients with depression or depression and anxiety; general practitioners believed brief psychological intervention was necessary for the patient |
Prospective, controlled trial with randomized and patient preference allocation arms; 197 patients were randomly assigned to treatment; 137 chose their treatment; 130 were randomized only between 2 psychological therapies |
|
Depression outcome: BDI scores |
There were no significant differences in BDI scores between the randomized and preference groups at either 4 or 12 mo |
