Preferences for Depression Treatment Including Internet-Based Interventions: Results From a Large Sample of Primary Care Patients

Marie Dorow, Margrit Löbner, Alexander Pabst, Janine Stein, Steffi G Riedel-Heller, Marie Dorow, Margrit Löbner, Alexander Pabst, Janine Stein, Steffi G Riedel-Heller

Abstract

Background: To date, little is known about treatment preferences for depression concerning new media. This study aims to (1) investigate treatment preferences for depression including internet-based interventions and (2) examine subgroup differences concerning age, gender and severity of depression as well as patient-related factors associated with treatment preferences. Methods: Data were derived from the baseline assessment of the @ktiv-trial. Depression treatment preferences were assessed from n = 641 primary care patients with mild to moderate depression regarding the following treatments: medication, psychotherapy, combined treatment, alternative treatment, talking to friends and family, exercise, self-help literature, and internet-based interventions. Depression severity was specified by GPs according to ICD-10 criteria. Ordinal logistic regression models were conducted to identify associated factors of treatment preferences. Results: Patients had a mean age of 43.9 years (SD = 13.8) and more than two thirds (68.6%) were female. About 43% of patients had mild depression while 57% were diagnosed with moderate depression. The majority of patients reported strong preferences for psychotherapy, talking to friends and family, and exercise. About one in five patients was very likely to consider internet-based interventions in case of depression. Younger patients expressed significantly stronger treatment preferences for psychotherapy and internet-based interventions than older patients. The most salient factors associated with treatment preferences were the patients' education and perceived self-efficacy. Conclusions: Patients with depression report individually different treatment preferences.Our results underline the importance of shared decision-making within primary care. Future studies should investigate treatment preferences for different types of internet-based interventions.

Keywords: depression; e-mental health; iCBT; new media; primary care; treatment preferences.

Figures

Figure 1
Figure 1
Treatment preferences for depression in primary care. 1Endorsement: likely or very likely; 2Rejection: unlikely or very unlikely; an = 637; bn = 633; cCombined treatment refers to medication and psychotherapy, n = 615; dAlternative treatment (e.g. alternative practitioners), n = 623; en = 634; fn = 638; gn = 629; hn = 631; percentage of respondents “undecided”: an = 132 (21%); bn = 125 (20%); cn = 135 (22%); dn = 141 (23%); en = 122 (19%); fn = 159 (25%); gn = 154 (24%); hn = 127 (20%).

References

    1. Berkowitz SA, Bell RA, Kravitz RL, Feldman MD. Vicarious experience affects patients' treatment preferences for depression. PLoS ONE (2012) 7:e31269. 10.1371/journal.pone.0031269
    1. Gensichen J, Huchzermeier C, Aldenhoff JB, Gerlach FM, Hinze-Selch D. Signals for the initiation of structured diagnostic procedures for depression in primary health care. A practice-relevant evaluation of international guidelines. Z Ärztl Fortbild Qualitätssich. (2005) 99:57–63.
    1. Jacobi F, Höfler M, Meister W, Wittchen HU. Prevalence, detection and prescribing behavior in depressive syndromes. A German federal family physician study. Nervenarzt (2002) 73:651–8. 10.1007/s00115-002-1299-y
    1. Goldman LS, Nielsen NH, Champion HC. Awareness, diagnosis, and treatment of depression. J Gen Intern Med. (1999) 14:569–80. 10.1046/j.1525-1497.1999.03478.x
    1. Linden M, Maier W, Achberger M, Herr R, Helmchen H, Benkert O. Psychiatric diseases and their treatment in general practice in Germany. Results of a World Health Organization (WHO) study. Nervenarzt (1996) 67:205–15.
    1. Pincus HA, Davis WW, McQueen LE. ‘Subthreshold’ mental disorders. Br J Psychiatry (1999) 174:288–96.
    1. Churchill R, Khaira M, Gretton V, Chilvers C, Dewey M, Duggan C, et al. . Treating depression in general practice: factors affecting patients' treatment preferences. Br J Gen Pract. (2000) 50:905–6.
    1. Gelhorn HL, Sexton CC, Classi PM. Patient preferences for treatment of major depressive disorder and the impact on health outcomes: a systematic review. Prim Care Companion CNS Disord. (2011) 13:PCC.11r01161. 10.4088/PCC.11r01161
    1. DGPPN, BÄK, KBV, AWMF for the guideline group unipolar depression S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression – Langfassung, 2. Auflage. Version 5 (2015). Available online at: (Accessed Augest 10, 2017).
    1. Härter M, Loh A, Spies C. Gemeinsam entscheiden - erfolgreich behandeln. Neue Wege für Ärzte und Patienten im Gesundheitswesen. Köln: Deutscher Ärzte-Verlag; (2005).
    1. Elwyn G, Edwards A, Mowle S, Wensing M, Wilkinson C, Kinnersley P, et al. . Measuring the involvement of patients in shared decision-making: a systematic review of instruments. Patient Educ Couns. (2001) 43:5–22. 10.1016/S0738-3991(00)00149-X
    1. Steidtmann D, Manber R, Arnow BA, Klein DN, Markowitz JC, Rothbaum BO, et al. . Patient treatment preference as a predictor of response and attrition in treatment for chronic depression. Depress Anxiety (2012) 29:896–905. 10.1002/da.21977
    1. Johansson R, Nyblom A, Carlbring P, Cuijpers P, Andersson G. Choosing between Internet-based psychodynamic versus cognitive behavioral therapy for depression: a pilot preference study. BMC Psychiatry (2013) 13:268. 10.1186/1471-244X-13-268
    1. Schuster R, Berger T, Laireiter A-R. Computer und Psychotherapie – geht das zusammen? Psychotherapeut (2017) 75:e695 10.1007/s00278-017-0214-8.
    1. Kleiboer A, Smit J, Bosmans J, Ruwaard J, Andersson G, Topooco N, et al. . European COMPARative Effectiveness research on blended Depression treatment versus treatment-as-usual (E-COMPARED): study protocol for a randomized controlled, non-inferiority trial in eight European countries. Trials (2016) 17:387. 10.1186/s13063-016-1511-1
    1. Luck-Sikorski C, Stein J, Heilmann K, Maier W, Kaduszkiewicz H, Scherer M, et al. . Treatment preferences for depression in the elderly. Int Psychogeriatr. (2017) 29:389–98. 10.1017/S1041610216001885
    1. Angermeyer MC, Matschinger H, Riedel-Heller SG. Whom to ask for help in case of a mental disorder? Preferences of the lay public. Soc Psychiatry Psychiatr Epidemiol. (1999) 34:202–10. 10.1007/s001270050134
    1. Brauns H, Steinmann S. Educational reform in France, West-Germany and the United Kingdom: updating the CASMIN educational classification. ZUMA Nachrichten (1999) 23:7–44.
    1. Löwe B, Spitzer R, Zipfel S, Herzog W. Gesundheitsfragebogen für Patienten (PHQ D). Komplettversion und Kurzform. Testmappe mit Manual, Fragebögen, Schablonen. 2. Auflage: Pfizer; (2002).
    1. Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy FV3, Hahn SR, et al. . Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA (1994) 272:1749–56. 10.1001/jama.1994.03520220043029
    1. Kilian R, Becker T, Schleuning G, Welschehold M, Hertle C, Matschinger H, et al. Die Entwicklung eines Standardisierten Verfahrens zur Messung von Empowerment im Prozess der psychiatrischen Behandlung von Patienten mit Schweren Psychischen Erkrankungen. Ulm: Abschlussbericht Förderkennz; 101GX0743 (2012).
    1. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. . Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. (2011) 20:1727–36. 10.1007/s11136-011-9903-x
    1. White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. (2011) 30:377–99. 10.1002/sim.4067
    1. Cuzick J. A Wilcoxon-type test for trend. Stat Med. (1985) 4:87–90. 10.1002/sim.4780040112
    1. Wolfe R, Gould W. An approximate likelihood-ratio test for ordinal response models. Stata Tech Bull. (1998) 7:1–52.
    1. Raue PJ, Schulberg HC, Heo M, Klimstra S, Bruce ML. Patients' depression treatment preferences and initiation, adherence, and outcome: a randomized primary care study. Psychiatr Serv. (2009) 60:337–43. 10.1176/ps.2009.60.3.337
    1. Van Schaik DJF, Klijn AFJ, van Hout HPJ, van Marwijk HWJ, Beekman ATF, Haan M de, et al. . Patients' preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry (2004) 26:184–9. 10.1016/j.genhosppsych.2003.12.001
    1. Löwe B, Schulz U, Gräfe K, Wilke S. Medical patients' attitudes toward emotional problems and their treatment. What do they really want? J Gen Intern Med. (2006) 21:39–45. 10.1111/j.1525-1497.2005.0266.x
    1. Khalsa S-R, McCarthy KS, Sharpless BA, Barrett MS, Barber JP. Beliefs about the causes of depression and treatment preferences. J Clin Psychol. (2011) 67:539–49. 10.1002/jclp.20785
    1. Dwight-Johnson M, Sherbourne CD, Liao D, Wells KB. Treatment preferences among depressed primary care patients. J Gen Intern Med. (2000) 15:527–34. 10.1046/j.1525-1497.2000.08035.x
    1. Iacoviello BM, McCarthy KS, Barrett MS, Rynn M, Gallop R, Barber JP. Treatment preferences affect the therapeutic alliance: implications for randomized controlled trials. J Consult Clin Psychol. (2007) 75:194–8. 10.1037/0022-006X.75.1.194
    1. Mergl R, Henkel V, Allgaier A-K, Kramer D, Hautzinger M, Kohnen R, et al. . Are treatment preferences relevant in response to serotonergic antidepressants and cognitive-behavioral therapy in depressed primary care patients? Results from a randomized controlled trial including a patients' choice arm. Psychother Psychosom. (2011) 80:39–47. 10.1159/000318772
    1. Wittink MN, Cary M, Tenhave T, Baron J, Gallo JJ. Towards patient-centered care for depression: conjoint methods to tailor treatment based on preferences. Patient (2010) 3:145–57. 10.2165/11530660-000000000-00000
    1. Houle J, Villaggi B, Beaulieu M-D, Lespérance F, Rondeau G, Lambert J. Treatment preferences in patients with first episode depression. J Affect Disord. (2013) 147:94–100. 10.1016/j.jad.2012.10.016
    1. Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, et al. . Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. Lancet (2018) 391:1357–66. 10.1016/S0140-6736(17)32802-7
    1. Berner MM, Kriston L, Sitta P, Härter M. Treatment of depressive symptoms and attitudes towards treatment options in a representative German general population sample. Int J Psychiatry Clin Pract. (2008) 12:5–10. 10.1080/13651500701330783
    1. Hegerl U, Althaus D, Stefanek J. Public attitudes towards treatment of depression: effects of an information campaign. Pharmacopsychiatry (2003) 36:288–91. 10.1055/s-2003-45115
    1. Highet NJ, Hickie IB, Davenport TA. Monitoring awareness of and attitudes to depression in Australia. Med J Aust. (2002) 176(Suppl. 8):63–8.
    1. Gabriel A, Violata C. Depression literacy among patients and the public: a literature review. Primary Psychiatry (2010) 17:55–64.
    1. Zuroff DC, Blatt SJ. Vicissitudes of life after the short-term treatment of depression: roles of stress, social support, and personality. J Soc Clin Psychol. (2002) 21:473–96. 10.1521/jscp.21.5.473.22622
    1. Nasser EH, Overholser JC. Recovery from major depression: the role of support from family, friends, and spiritual beliefs. Acta Psychiatr Scand. (2005) 111:125–32. 10.1111/j.1600-0447.2004.00423.x
    1. Griffiths KM, Crisp DA, Barney L, Reid R. Seeking help for depression from family and friends: a qualitative analysis of perceived advantages and disadvantages. BMC Psychiatry (2011) 11:196. 10.1186/1471-244X-11-196
    1. Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, et al. Exercise for depression. Cochrane Database Syst Rev. (2013) 9:1–160. 10.1002/14651858
    1. Hallgren M, Kraepelien M, Öjehagen A, Lindefors N, Zeebari Z, Kaldo V, et al. . Physical exercise and internet-based cognitive-behavioural therapy in the treatment of depression: Randomised controlled trial. Br J Psychiatry (2015) 207:227–34. 10.1192/bjp.bp.114.160101
    1. Givens JL, Houston TK, van Voorhees BW, Ford DE, Cooper LA. Ethnicity and preferences for depression treatment. Gen Hosp Psychiatry (2007) 29:182–91. 10.1016/j.genhosppsych.2006.11.002
    1. Fernandez y Garcia E, Franks P, Jerant A, Bell RA, Kravitz RL. Depression treatment preferences of Hispanic individuals: exploring the influence of ethnicity, language, and explanatory models. J Am Board Fam Med. (2011) 24:39–50. 10.3122/jabfm.2011.01.100118
    1. Rhee TG, Harris IM. Gender differences in the use of complementary and alternative medicine and their association with moderate mental distress in U.S. adults with migraines/severe headaches. Headache (2017) 57:97–108. 10.1111/head.12986
    1. McLean S, Kapell B. She reads, he reads: gender differences and learning through self-help books. RELA (2015) 6:55–72. 10.3384/rela.2000-7426.rela0138
    1. Boehlen FH, Herzog W, Maatouk I, Saum K-U, Brenner H, Wild B. Treatment preferences of elderly patients with mental disorders. Z Gerontol Geriatr. (2016) 49:120–5. 10.1007/s00391-015-0908-x
    1. Kitchen KA, McKibbin CL, Wykes TL, Lee AA, Carrico CP, McConnell KA. Depression treatment among rural older adults: preferences and factors influencing future service use. Clin Gerontol. (2013) 36:1–15. 10.1080/07317115.2013.767872
    1. Da Silva PFR, Blay SL. Prevalence and characteristics of outpatient psychotherapy use: a systematic review. J Nerv Ment Dis. (2010) 198:783–9. 10.1097/NMD.0b013e3181f97e1f
    1. Reavley NJ, Morgan AJ, Jorm AF. Development of scales to assess mental health literacy relating to recognition of and interventions for depression, anxiety disorders and schizophrenia/psychosis. Aust N Z J Psychiatry (2014) 48:61–9. 10.1177/0004867413491157
    1. Dunn KI, Goldney RD, Grande ED, Taylor A. Quantification and examination of depression-related mental health literacy. J Eval Clin Pract. (2009) 15:650–3. 10.1111/j.1365-2753.2008.01067.x
    1. Kaneko Y, Motohashi Y. Male gender and low education with poor mental health literacy: a population-based study. J Epidemiol. (2007) 17:114–9. 10.2188/jea.17.114
    1. Mackenzie CS, Gekoski WL, Knox VJ. Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging Ment Health (2006) 10:574–82. 10.1080/13607860600641200
    1. Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, et al. . Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med. (2005) 352:2515–23. 10.1056/NEJMsa043266
    1. Dunlop BW, Kelley ME, Mletzko TC, Velasquez CM, Craighead WE, Mayberg HS. Depression beliefs, treatment preference, and outcomes in a randomized trial for major depressive disorder. J Psychiatr Res. (2012) 46:375–81. 10.1016/j.jpsychires.2011.11.003
    1. Christensen H, Griffiths KM, Evans K. e-Mental Health in Australia: Implications of the Internet and Related Technologies for Policy: ISC Disussion Paper No.3. Canberra, ACT: Commonwealth Department of Health and Ageing; (2002).
    1. Karyotaki E, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, Mira A, et al. . Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms: a meta-analysis of individual participant data. JAMA Psychiatry (2017) 74:351–9. 10.1001/jamapsychiatry.2017.0044
    1. Sikorski C, Luppa M, Kersting A, König H-H, Riedel-Heller SG. Computer-aided cognitive behavioral therapy for depression. Psychiatr Prax. (2011) 38:61–8. 10.1055/s-0030-1248575
    1. Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. (2012) 32:329–42. 10.1016/j.cpr.2012.02.004
    1. Stein J, Röhr S, Luck T, Löbner M, Riedel-Heller SG. Indication and evidence of internationally developed online coaches as intervention for mental illness - a meta-review. Psychiatr Prax. (2017) 45:7–15. 10.1055/s-0043-117050
    1. Rost T, Stein J, Löbner M, Kersting A, Luck-Sikorski C, Riedel-Heller SG. User acceptance of computerized cognitive behavioral therapy for depression: systematic review. J Med Internet Res. (2017) 19:e309. 10.2196/jmir.7662
    1. Riedel-Heller SG, Gühne U, Weinmann S, Becker T. Psychosocial therapies in severe mental illness: DGPPN-S3-guideline: evidence, recommendations and challenges for mental health service research. Psychother Psychosom Med Psychol. (2012) 62:425–8. 10.1055/s-0032-1327676
    1. Riedel-Heller SG, Gühne U, Weinmann S, Arnold K, Ay E-S, Becker T. Psychosocial interventions in severe mental illness: evidence and recommendations: psychoeducation, social skill training and exercise. Nervenarzt (2012) 83:847–54. 10.1007/s00115-011-3471-8
    1. Klein JP, Gerlinger G, Knaevelsrud C, Bohus M, Meisenzahl E, Kersting A, et al. Internetbasierte interventionen in der behandlung psychischer storungen: uberblick, qualitatskriterien, perspektiven. Nervenarzt (2016) 87:1185–93. 10.1007/s00115-016-0217-7
    1. Dorow M, Stein J, Förster F, Löbner M, Franz M, Günther R, et al. . Implementation of the internet-based self-management program “moodgym” in patients with depressive disorders in inpatient clinical settings - patient and expert perspectives. Psychiatr Prax. (2017). [Epub ahead of print]. 10.1055/s-0043-117049
    1. Batterham PJ, Calear AL. Preferences for internet-based mental health interventions in an adult online sample: findings from an online community survey. JMIR Ment Health (2017) 4:e26. 10.2196/mental.7722
    1. Statistisches Bundesamt. IT-Nutzung (2015). Available online at: . (Accessed June 28, 2016).
    1. Kruse RL, Koopman RJ, Wakefield BJ, Wakefield DS, Keplinger LE, Canfield SM, et al. . Internet use by primary care patients: where is the digital divide? Fam Med. (2012) 44:342–7.
    1. Eichenberg C, Wolters C, Brähler E. The internet as a mental health advisor in Germany–results of a national survey. PLoS ONE (2013) 8:e79206. 10.1371/journal.pone.0079206
    1. Löbner M, Stein J, Rost T, Förster F, Dorow M, Keller J, et al. Innovative E-Health-ansätze für komorbide depressionen bei patienten mit adipositas: nutzungsakzeptanz aus patienten- und expertenperspektive. Psychiatr Prax. (2017) 44:286–95. 10.1055/s-0043-107471
    1. Crisp DA, Griffiths KM. Participating in online mental health interventions: who is most likely to sign up and why? Depress Res Treat. (2014) 2014:790457. 10.1155/2014/790457
    1. Donkin L, Hickie IB, Christensen H, Naismith SL, Neal B, Cockayne NL, et al. . Sampling bias in an internet treatment trial for depression. Transl Psychiatry (2012) 2:e174. 10.1038/tp.2012.100
    1. Warmerdam L, van Straten A, Twisk J, Riper H, Cuijpers P. Internet-based treatment for adults with depressive symptoms: randomized controlled trial. J Med Internet Res. (2008) 10:e44. 10.2196/jmir.1094
    1. Høifødt RS, Lillevoll KR, Griffiths KM, Wilsgaard T, Eisemann M, Waterloo K, et al. . The clinical effectiveness of web-based cognitive behavioral therapy with face-to-face therapist support for depressed primary care patients: randomized controlled trial. J Med Internet Res. (2013) 15:e153. 10.2196/jmir.2714
    1. Mojtabai R, Olfson M, Mechanic D. Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Arch Gen Psychiatry (2002) 59:77–84. 10.1001/archpsyc.59.1.77
    1. Halmetoja CO, Malmquist A, Carlbring P, Andersson G. Experiences of internet-delivered cognitive behavior therapy for social anxiety disorder four years later: a qualitative study. Internet Interv. (2014) 1:158–63. 10.1016/j.invent.2014.08.001
    1. Wallin EEK, Mattsson S, Olsson EMG. The preference for internet-based psychological interventions by individuals without past or current use of mental health treatment delivered online: a survey study with mixed-methods analysis. JMIR Ment Health (2016) 3:e25. 10.2196/mental.5324
    1. Klein B, Cook S. Preferences for e-mental health services amongst an online Australian sample. E-J Appl Psychol. (2010) 6:28–39. 10.7790/ejap.v6i1.184
    1. Apolinario-Hagen J, Kemper J, Sturmer C. Public acceptability of E-mental health treatment services for psychological problems: a scoping review. JMIR Ment Health (2017) 4:e10. 10.2196/mental.6186
    1. Casey LM, Joy A, Clough BA. The impact of information on attitudes toward e-mental health services. Cyberpsychol Behav Soc Netw. (2013) 16:593–8. 10.1089/cyber.2012.0515
    1. Musiat P, Goldstone P, Tarrier N. Understanding the acceptability of e-mental health–attitudes and expectations towards computerised self-help treatments for mental health problems. BMC Psychiatry (2014) 14:109. 10.1186/1471-244X-14-109
    1. Schomerus G, Angermeyer MC, Baumeister SE, Stolzenburg S, Link BG, Phelan JC. An online intervention using information on the mental health-mental illness continuum to reduce stigma. Eur Psychiatry (2016) 32:21–7. 10.1016/j.eurpsy.2015.11.006
    1. Stolzenburg S, Freitag S, Evans-Lacko S, Muehlan H, Schmidt S, Schomerus G. The stigma of mental illness as a barrier to self labeling as having a mental illness. J Nerv Ment Dis. (2017) 205:903–9. 10.1097/NMD.0000000000000756
    1. Casey LM, Wright M-A, Clough BA. Comparison of perceived barriers and treatment preferences associated with internet-based and face-to-face psychological treatment of depression. Int J Cyber Behav Psychol Learn. (2014) 4:16–22. 10.4018/ijcbpl.2014100102

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir