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

2. 2
Correlates of Treatment Discussions
and Treatment Choices in
Depression – the TRENDS study
O. Kenrik Duru1, Bethany Gerstein2, Carrie Levin2, Vickie Stringfellow2,
John Wong3
1 David Geffen School of Medicine, UCLA
2 Informed Medical Decisions Foundation
3 Tufts Medical Center

3. 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 depression
includes difficulty with school, work, relationships, plus
increased rates of substance abuse and suicide
• Only 50% of Americans with depression receive
treatment (either medications or psychotherapy)
3

4. Preferences in Depression Treatment are Important
• For mild/moderate depression, medications and
psychotherapy are both effective as first-line therapy
• Although most patients express a preference for
psychotherapy, 10% receive first-line treatment with
psychotherapy alone
• Strong evidence that “matching” treatment to patient
preference improves adherence to therapy
• Moderate evidence that matching treatment to patient
preference improves outcomes
4

5. Research Questions:
1. What are the predictors of making a decision to start
or continue anti-depression medications?
2. What are the predictors of discussing non-medicinal
treatment options for depression with a provider?
5

6. Dataset
• Cross-sectional data from a national probability sample,
collected in the TRENDS study
• Participants were asked “Have you ever talked with a
health care provider about feelings of depression?”
• 385 responded yes, defined as having depression (the
analytic sample for this study)
6

7. Dependent Variables
• Analysis #1: Whether respondent made a decision to
start OR continue taking depression medication in the
last 2 years (vs. made a decision to stop or not to start)
• Analysis #2: Whether respondent talked “some” or “a
lot” with their HCP about options other than depression
medications (vs. “not at all” or “a little”)
7

8. 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

9. Predictor – Depression Treatment Knowledge Score
• Sum of 5 items, multiple-choice:
• Most effective Rx for mild/mod depression (A: either meds or
counseling)
• Most effective Rx for severe depression (A: both meds and
counseling)
• % of people who feel better within a year without treatment
(A: 25-49%)
• How soon to talk with HCP about stopping meds after feeling
better (A: 6-12 months)
• How long does one usually need counseling to reduce symptoms
(A: 6 months)
• Mean score 1.7 (0.9)
9

10. Predictor – Value Costs Score
• Includes 3 items measuring the importance of
medication “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

11. 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 of
1-4)
• 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

12. Results
12

13. Demographics (n=385)
100K+
65+
White
60-99K
F
55-64
Non-white
30-59K
M
45-54
15-29K
40-44
15K
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Race
Income
Gender
Age
13

14. Demographics (n=385)
P
Col Grad
Yes
F
Some college
No
G
HS Grad
VG
HS
E
0% 20% 40% 60% 80% 100%
Health Insurance
Health Status
Education
14

15. Analysis #1
(Decision to Start or Continue Medications)
15
N=368 Odds Ratio p
• Age 40-44 (vs. 65+) 0.27 0.004
Age 45-54 (vs. 65+) 1.42 0.40
Age 55-64 (vs. 65+) 1.66 0.25
• Male (vs. female) 0.92 0.79
• Income $15K-$29K (vs. $15K) 2.37 0.07
Income $30K-$59K (vs. $15K) 3.21 0.011
Income $60K-$99K (vs. $15K) 4.79 0.003
Income $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

16. Analysis #1
(Decision to Start or Continue Medications)
16
N=368 Odds Ratio p
Decision Process Score 0.80 0.10
Depression Treatment Knowledge Score 0.93 0.67
Value Costs Score 0.66 0.001
Importance of Quick Relief 1.24 0.006
Thought Medications Would Help 2.22 0.03
Feels Informed About Medications 1.26 0.002

17. Analysis #2
(Discussion of Rx Options other than Meds)
17
(n=373) Odds Ratio p
• Age 40-44 (vs. 65+) 1.72 0.14
Age 45-54 (vs. 65+) 1.84 0.06
Age 55-64 (vs. 65+) 1.03 0.93
• Male (vs. female) 1.00 0.99
• Income $15K-$29K (vs. $15K) 0.53 0.09
Income $30K-$59K (vs. $15K) 0.97 0.94
Income $60K-$99K (vs. $15K) 2.25 0.06
Income $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

18. Analysis #2
(Discussion of Rx Options other than Meds)
18
N=368 Odds Ratio p
Depression Treatment Knowledge Score 1.07 0.63
Value Costs Score 1.18 0.002
Importance of Quick Relief 0.94 0.33
Thought Medications Would Help 1.03 0.91
Feels Informed About Medications 1.23 0.001

19. Summary of Results
• Overall, patients with depression have high quality
decision processes, and appear to be making decisions
consistent with their values
• Patients with worse health status and who desire quick
relief are more likely to take medications
• Patients concerned about downsides of medications are
less likely to take them
• Minorities are more likely to discuss non-medicinal
options (? stigma)
• Patients without health insurance less likely to take
medications or discuss non-medicinal options
19