Patient preferences for treatment of major depressive disorder and the impact on health outcomes: a systematic review.

OBJECTIVE: To summarize the peer-reviewed literature on patient preferences for depression treatments and the impact of these preferences on the outcomes of treatment. DATA SOURCES: Studies were identified via a systematic search conducted simultaneously in PsycINFO and MEDLINE using EBSCOhost and EMBASE. Publications were retrieved in March 2010. STUDY SELECTION: Search terms included depression OR MDD OR major depressive disorder, patient preference, treatment preference, intervention preference, and pharmacotherapy preference. There were no restrictions on years of publication. The search was restricted to research articles written in English. DATA EXTRACTION: Fifteen articles contained unique information on patient preferences for depression treatments and their impact on depression-related outcomes.
RESULTS: The patient preference literature includes a limited number of studies examining the impact of patient preferences on outcomes such as depression severity, treatment initiation, persistence and adherence, treatment engagement, the development of the therapeutic alliance, and health-related quality of life. The majority of the preference research has focused on comparisons of psychotherapy versus pharmacotherapy, with some limited information regarding comparisons of psychotherapies. Results from the research to date suggest that the impact of patient treatment preferences is mixed. The results also indicate that patient preferences have minimal impact on depression severity outcomes within the context of controlled clinical trials but may be more strongly associated with other outcomes such as entry into treatment and development of the therapeutic alliance. However, it is important to note that the literature is limited in that the impact of patient preference has been examined only through secondary analyses, and there have been few studies designed explicitly to examine the impact of patient preferences, particularly outside the context of controlled clinical trials.
CONCLUSIONS: Consideration of patient preferences for depression treatments may lead to increased treatment initiation and improved therapeutic alliance. However, despite treatment guidelines and suggestions in the literature, the value of and appropriate procedures for considering patient preferences in real-world treatment decisions deserves more careful study. Further research is needed, and future studies should be conducted in more naturalistic treatment settings that examine patient preferences for other specific approaches to depression treatments including preferences related to comparisons of individual pharmacotherapies and second-step treatments.