Preferences for Treatments for Major Depressive Disorder: Formative Qualitative Research Using the Patient Experience

Area of Science:

• Psychiatry and Mental Health
• Health Services Research
• Patient-Reported Outcomes

Background:

• Major depressive disorder (MDD) significantly impacts individuals' lives, necessitating treatments aligned with patient priorities.
• Current treatment selection may not fully capture patient preferences regarding efficacy, duration, and cost.
• Understanding patient trade-offs is crucial for developing patient-centered depression care strategies.

Purpose of the Study:

• To identify key treatment attributes and desired outcomes for individuals with major depressive disorder (MDD).
• To develop and pre-test a stated preference instrument, specifically a discrete choice experiment (DCE), for assessing MDD treatment preferences.
• To inform the design of more effective and patient-aligned depression management strategies.

Main Methods:

• A three-phase survey study involving 20 adults with MDD to design and pre-test a discrete choice experiment (DCE) instrument.
• Engagement with patient advocates and a multi-disciplinary advisory group to refine DCE attributes.
• Pre-testing the DCE instrument with ten adults diagnosed with MDD.

Main Results:

• Six initial attributes were identified: treatment mode, time to effect, hopefulness, productivity impact, social relations, and out-of-pocket costs.
• Refinements were made to treatment mode (medicine, medicine + psychotherapy, all modalities), time to effect (4, 6, 9 weeks), and monthly costs ($30, $90, $270).
• MDD treatment preferences indicated significant trade-offs between treatment modality, speed of effect, functional outcomes, and cost.

Conclusions:

• Patient preferences for major depressive disorder (MDD) treatments involve complex trade-offs.
• Incorporating patient-reported preferences into decision-making tools can enhance the relevance and effectiveness of depression treatments.
• This research highlights the value of patient-centered approaches in mental health care.