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Correlates of Treatment Discussions and Treatment Choices in Depression - the TRENDS Study
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Correlates of Treatment Discussions and Treatment Choices in Depression - the TRENDS Study

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2013 Winter Medical Editor's Meeting: Kenrik Duru, MD, MSHS

2013 Winter Medical Editor's Meeting: Kenrik Duru, MD, MSHS

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  • 1. 2Correlates of Treatment Discussionsand Treatment Choices inDepression – the TRENDS studyO. Kenrik Duru1, Bethany Gerstein2, Carrie Levin2, Vickie Stringfellow2,John Wong31 David Geffen School of Medicine, UCLA2 Informed Medical Decisions Foundation3 Tufts Medical Center
  • 2. Depression is Serious and Undertreated • The lifetime prevalence of depression in the US is 17%• Health care costs for depressed patients are 50%-100%higher• The high social burden associated with depressionincludes difficulty with school, work, relationships, plusincreased rates of substance abuse and suicide• Only 50% of Americans with depression receivetreatment (either medications or psychotherapy)3
  • 3. Preferences in Depression Treatment are Important • For mild/moderate depression, medications andpsychotherapy are both effective as first-line therapy• Although most patients express a preference forpsychotherapy, <10% receive first-line treatment withpsychotherapy alone• Strong evidence that “matching” treatment to patientpreference improves adherence to therapy• Moderate evidence that matching treatment to patientpreference improves outcomes4
  • 4. Research Questions: 1.  What are the predictors of making a decision to startor continue anti-depression medications?2. What are the predictors of discussing non-medicinaltreatment options for depression with a provider?5
  • 5. Dataset • Cross-sectional data from a national probability sample,collected in the TRENDS study• Participants were asked “Have you ever talked with ahealth care provider about feelings of depression?”• 385 responded yes, defined as having depression (theanalytic sample for this study)6
  • 6. Dependent Variables • Analysis #1: Whether respondent made a decision tostart OR continue taking depression medication in thelast 2 years (vs. made a decision to stop or not to start)• Analysis #2: Whether respondent talked “some” or “alot” with their HCP about options other than depressionmedications (vs. “not at all” or “a little”)7
  • 7. Predictor – Decision Process Score • Sum of 4 items measuring SDM:• Discussion of pros• Discussion of cons• Patient input asked• Choices explained• Mean score: 2.7 (1.2)8
  • 8. Predictor – Depression Treatment Knowledge Score • Sum of 5 items, multiple-choice:• Most effective Rx for mild/mod depression (A: either meds orcounseling)• Most effective Rx for severe depression (A: both meds andcounseling)• % of people who feel better within a year without treatment(A: 25-49%)• How soon to talk with HCP about stopping meds after feelingbetter (A: 6-12 months)• How long does one usually need counseling to reduce symptoms(A: <6 months)• Mean score 1.7 (0.9)9
  • 9. Predictor – Value Costs Score • Includes 3 items measuring the importance ofmedication “downsides,” range 0-10• Importance of avoiding medication side effects• Importance of minimizing out-of-pocket costs• Importance of avoiding medications• Mean score 6.4 (2.4)10
  • 10. Other Predictors • Importance of quick relief (range of 0-10)• Mean score 8.6 (2.1)• How much did you think medications would help? (range of1-4)• Mean score 3.1 (0.8)• How informed do you feel about depression medications?(range of 0-10)• Mean score 7.1 (2.3)11
  • 11. Results 12
  • 12. Demographics (n=385) 100K+65+White60-99KF55-64Non-white30-59KM45-5415-29K40-44<15K0% 10% 20% 30% 40% 50% 60% 70% 80% 90%RaceIncomeGenderAge13
  • 13. Demographics (n=385) PCol GradYesFSome collegeNoGHS GradVG<HSE0% 20% 40% 60% 80% 100%Health InsuranceHealth StatusEducation14
  • 14. Analysis #1 (Decision to Start or Continue Medications) 15N=368 Odds Ratio p• Age 40-44 (vs. 65+) 0.27 0.004Age 45-54 (vs. 65+) 1.42 0.40Age 55-64 (vs. 65+) 1.66 0.25• Male (vs. female) 0.92 0.79• Income $15K-$29K (vs. <$15K) 2.37 0.07Income $30K-$59K (vs. <$15K) 3.21 0.011Income $60K-$99K (vs. <$15K) 4.79 0.003Income $100K+ (vs. <$15K) 0.77 0.60• Non-white (vs. white) 0.61 0.16• Health status (1-5 scale, 5=poor) 1.75 0.001• No health insurance (vs. insured) 0.27 0.01
  • 15. Analysis #1 (Decision to Start or Continue Medications) 16N=368 Odds Ratio pDecision Process Score 0.80 0.10Depression Treatment Knowledge Score 0.93 0.67Value Costs Score 0.66 <0.001Importance of Quick Relief 1.24 0.006Thought Medications Would Help 2.22 0.03Feels Informed About Medications 1.26 0.002
  • 16. Analysis #2 (Discussion of Rx Options other than Meds) 17(n=373) Odds Ratio p• Age 40-44 (vs. 65+) 1.72 0.14Age 45-54 (vs. 65+) 1.84 0.06Age 55-64 (vs. 65+) 1.03 0.93• Male (vs. female) 1.00 0.99• Income $15K-$29K (vs. <$15K) 0.53 0.09Income $30K-$59K (vs. <$15K) 0.97 0.94Income $60K-$99K (vs. <$15K) 2.25 0.06Income $100K+ (vs. <$15K) 0.68 0.36• Non-white (vs. white) 2.28 0.004• Health status (1-5 scale, 5=poor) 1.33 0.045• No health insurance (vs. insured) 0.24 <0.001
  • 17. Analysis #2 (Discussion of Rx Options other than Meds) 18N=368 Odds Ratio pDepression Treatment Knowledge Score 1.07 0.63Value Costs Score 1.18 0.002Importance of Quick Relief 0.94 0.33Thought Medications Would Help 1.03 0.91Feels Informed About Medications 1.23 <0.001
  • 18. Summary of Results • Overall, patients with depression have high qualitydecision processes, and appear to be making decisionsconsistent with their values• Patients with worse health status and who desire quickrelief are more likely to take medications• Patients concerned about downsides of medications areless likely to take them• Minorities are more likely to discuss non-medicinaloptions (? stigma)• Patients without health insurance less likely to takemedications or discuss non-medicinal options19