Primary care patients' involvement in decision-making is associated with improvement in depression

Med Care. 2006 May;44(5):398-405. doi: 10.1097/01.mlr.0000208117.15531.da.


Background: Depression is undertreated in primary care settings. Little research investigates the impact of patient involvement in decisions on guideline-concordant treatment and depression outcomes.

Objective: The objective of this study was to determine whether patient involvement in decision-making is associated with guideline-concordant care and improvement in depression symptoms.

Design: Prospective cohort study.

Setting: Multisite, nationwide randomized clinical trial of quality improvement strategies for depression in primary care.

Subjects: Primary care patients with current symptoms and probable depressive disorder.

Measurements: Patients rated their involvement in decision-making (IDM) about their care on a 5-point scale from poor to excellent 6 months after entry into the study. Depressive symptoms were measured every 6 months for 2 years using a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. We examined probabilities (Pr) of receipt of guideline-concordant care and resolution of depression across IDM groups using multivariate logistic regression models controlling for patient and provider factors.

Results: For each 1-point increase in IDM ratings, the probability of patients' report of receiving guideline-concordant care increased 4% to 5% (adjusted Pr 0.31 vs. 0.50 for the lowest and highest IDM ratings, respectively, P < 0.001). Similarly, for each 1-point increase in IDM ratings, the probability of depression resolution increased 2% to 3% (adjusted Pr 0.10 vs. 0.19 for the lowest and highest IDM ratings respectively, P = 0.004).

Conclusions: Depressed patients with higher ratings of involvement in medical decisions have a higher probability of receiving guideline-concordant care and improving their symptoms over an 18-month period. Interventions to increase patient involvement in decision-making may be an important means of improving care for and outcomes of depression.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Decision Making*
  • Depression / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data
  • Patient Participation / methods*
  • Patient Participation / statistics & numerical data
  • Patient Satisfaction
  • Practice Guidelines as Topic
  • Primary Health Care / methods*
  • Primary Health Care / standards
  • Primary Health Care / statistics & numerical data
  • Prospective Studies
  • Socioeconomic Factors
  • Treatment Outcome
  • United States