Identification of patient attitudes and preferences regarding treatment of depression.

OBJECTIVES: To identify attitudes that influence patient help-seeking behavior and aspects of treatment that influence patient preferences for management of depression. DESIGN: Three focus group discussions (two patient groups stratified by race and one professional group). Questions addressed experience with depression, help-seeking behaviors, treatment preferences, and perceived barriers to mental health care. SETTING: Academic medical center. PATIENTS/PARTICIPANTS: Eight black patients and eight white patients with depression: seven health care professionals (four physicians and three social workers). MEASUREMENTS AND MAIN RESULTS: Discussions were audiotaped, transcribed, and reviewed independently by two investigators to identify and group distinct comments into categories with specific themes. Differences were adjudicated by a third investigator. Comments within categories were then checked for relevance and consistency by a health services researcher and a psychiatrist. More than 90% of the 806 comments could be grouped into one of 16 categories. Black patients raised more concerns than white patients regarding spirituality and stigma. Patients made more comments than professionals regarding the impact of spirituality, social support systems, coping strategies, life experiences, patient-provider relationships, and attributes of specific treatments. They discussed the role these factors played in their help-seeking behavior and adherence to treatment. CONCLUSIONS: In-depth focus group discussions with depressed patients can provide valuable and unique information about patient experiences and concerns regarding treatment for depression. Clinicians, researchers, and policymakers need to incorporate the range of factors identified by patients into their decision making for individuals with depression.