Great expectations: factors influencing patient expectations and doctors recommendations at a Mood Disorders Unit

Literature about expectations and management of depression within community samples reflects attitudes of people who have generally not received treatment. We examined the factors influencing treatment expectations and psychiatrists' treatment recommendations for patients referred to a mood disorders unit with identified episodes of major depression.

Prior to attending a mood disorders unit, 182 men and women who met DSM-III-R or DSM-IV criteria for current major depression provided data on sociodemographic details, history of medical and psychiatric illness and expectations of treatment. Psychiatrists' treatment recommendations to the referring clinician were assessed to determine whether the patients' initial expectations were met.

Data analyses revealed three factors relating to patients' expectations: "enhanced coping", "providing fresh ideas for the referring doctor" and "providing fresh ideas to self". Patients' expectations were influenced by sociodemographic and illness-related characteristics. In particular, young female patients typically expected to receive strategies to enhance coping, while those with lifetime anxiety expected less active involvement on their part. Some clinicians' recommendations were dependent upon depression type and patient factors. Women and those with a history of anxiety disorders received more education and recommendations for relationship counselling and support groups.

The study design did not allow determination of the impact of patients' expectations on the psychiatrists' recommendations.

Individual and illness characteristics are important predictors of treatment expectations prior to specialist care. It appears that doctors take these factors into account with implications for patients' satisfaction with the type of care recommended.