How Much Shared Decision Making Occurs in Usual Primary Care of Depression?

Article Figures & Data

Table 1. Shared Decision-Making Questions (N = 1168 Respondents)

Questions	Yes Responses (%)
During the past 6 months of depression treatment, were you:
1. Asked for your ideas and preferences regarding your depression treatment?	37.0
2. Asked about your concerns and questions with regard to depression treatment?	57.6
3. Sure that your doctor considered your values and goals when recommending treatment?	75.2
4. Provided with a treatment plan you could do in your daily life?	60.6
5. Asked about any problems or side effects from your treatments?	42.4
6. Asked whether you preferred medications or counseling?	34.2
Composite (standard deviation)	50.7 (32.8)

Table 2. Personal, Clinic, and Group Characteristics of 1168 Enrolled Patients

Characteristics	No.	%
Patients
Sex
Female	851	72.9
Male	317	27.1
Age (years)
18–34	344	29.5
35–49	391	33.5
50–64	347	39.7
≥65	86	7.4
Ethnicity/race
Non-Hispanic white	1022	87.5
Hispanic, any race	43	3.7
Non-Hispanic, nonwhite	103	8.8
Treated for this depression
0–5 weeks	543	46.5
≥6 weeks	607	52.0
Other depression treatment in past 6 months
Individual counseling	299	25.6
Group therapy	45	3.8
Psychiatry	69	5.9
Other treatment	41	3.5
Any treatment	376	32.2
General health
Excellent/very good	383	32.8
Good	437	37.4
Fair/poor	348	29.8
PHQ-9 score
7–9	367	31.4
10–14	446	38.2
15–19	244	20.9
≥20	111	9.5
Education
High school or less	355	30.4
Some college, trade school	468	40.1
College degree or more	345	29.5
Marital status
Married	569	48.7
Unmarried couple	101	8.6
Divorced/separated/widowed	268	22.9
Never married	229	19.6
Employment
Employed for wages	696	59.6
Self-employed	69	5.9
Unemployed	117	10.0
Homemaker	45	3.9
Student	47	4.0
Retired	82	7.0
Unable to work	112	9.6
Household income
Below poverty threshold	205	17.5
Between threshold and 2× threshold	166	14.2
More than 2× threshold	749	64.1
Declined to answer	48	4.1
Insurance type
Commercial	792	67.8
State programs^*	270	23.1
Medicare	61	5.2
Other	34	2.9
Clinics
Adult PCPs in clinic (n)
1–4	159	13.6
5–10	510	43.7
≥11	497	42.6
NPs/PAs in clinic (n)
0	124	10.6
≥1	1044	89.4
Clinic location
Urban	714	61.1
Rural	454	38.9
Medical groups
Care sites in group (n)
1–4	274	23.5
5–10	98	8.4
≥11	796	68.2
Psychiatrists in group (n)
0	390	33.4
≥1	778	66.6
Mental health therapists in group (n)
0	385	33.0
≥1	783	67.0

↵* Medical Assistance, Prepaid Medical Assistance, Minnesota Care, Minnesota Senior Health Options.
NP, nurse practitioner; PA, physician assistant; PCP, primary care physician; PHQ-9, 9-item Patient Health Questionnaire.

Table 3. Bivariate Relationships Between Patient, Clinic, and Group Characteristics and Shared Decision Making

Characteristics	No.	Mean^*	SD	P Value
Patients
Sex
Female	848	51.2	33.0	.40
Male	314	49.4	32.2
Age (years)
18–34	343	58.3	31.0	.03
35–49	390	53.3	32.4
50–64	345	44.5	32.8	<.001
≥65	84	32.7	31.1	<.0001
Ethnicity/race
Non-Hispanic white	1016	50.4	33.2
Hispanic, any race	43	45.7	30.9	.36
Non-Hispanic, nonwhite	103	55.8	29.4	.11
Treated for this depression
0–5 weeks	540	56.6	29.7	<.001
≥6 weeks	604	45.5	34.5
Any other depression treatment in past 6 months
No	788	46.0	33.1
Yes	371	60.5	30.0	<.0001
General health
Excellent/very good/good	815	53.9	32.1
Fair/poor	347	43.1	33.2	<.001
PHQ-9 score
7–9	364	51.6	32.0	.75
10–14	444	50.8	33.5
15–19	243	49.9	32.6	.71
≥20	111	49.1	33.2	.62
Education
High school or less	354	47.2	31.6	.02
Some college, trade school	466	51.5	32.7	.46
College degree or more	342	53.2	34.0
Marital status
Coupled	666	51.6	32.5
Not coupled	495	49.4	33.2	.26
Employment
Employed	761	52.9	32.4
Not employed	401	46.5	33.2	.001
Household income
Below 2× poverty threshold	389	49.1	32.5
Above 2× poverty threshold	744	52.0	33.1	.15
Insurance type
Commercial	787	52.2	33.1
State programs	270	52.1	31.8	.95
Medicare	60	29.4	27.8	<.0001
Other	34	42.6	30.2	.09
Clinics
Adult PCPs in clinic (n)
1–4	159	49.5	32.3
5–10	506	51.6	32.4
≥11	495	50.0	33.5
NPs/PAs in clinic (n)
0	122	50.3	31.3
≥1	1038	50.7	33.0
Clinic location
Urban	709	50.1	32.8
Nonurban	453	51.6	32.8
Medical groups
Care sites in group (n)
1 to 4	273	54.1	32.2
5 to 10	98	44.4	30.5
≥11	791	50.3	33.2
Psychiatrists in group (n)
0	389	50.3	31.6
≥1	773	50.9	33.4
Mental health therapists in group (n)
0	384	51.4	31.6
≥1	778	50.3	33.4

↵* Mean percentage of 6 items answered yes.
NP, nurse practitioner; PA, physician assistant; PCP, primary care physician; PHQ-9, 9-item Patient Health Questionnaire; SD, standard deviation.

Table 4. Multivariate Model-Predicted Differences in Shared Decision Making Among Selected Patient Subgroups Relative to a Reference Group

Characteristics	Only Main Effects		Main Effects Plus Interaction
Characteristics	Difference	P Value^*	Difference	P Value^*
Sex
Female	Ref		Ref
Male	−2.2	.29	N/A
Age (years)
18–34	4.2	.08	4.1	.08
35–49	Ref		Ref
50–64	−7.6	.001	−7.8	<.001
≥65	−16.0	<.001	−15.9	<.001
Ethnicity/race
Non-Hispanic white	Ref		Ref
Hispanic, any race	−5.0	.31	N/A
Non-Hispanic, nonwhite	4.2	.21	N/A
Treated for this depression
0–5 weeks	Ref		Ref
≥6 weeks	−11.0	<.001	−11.2	<.001
Any other depression treatment in past 6 months
No	Ref		Ref
Yes	14.0	<.0001	14.0	<.001
General health
Excellent/very good/good	Ref		Ref
Fair/poor	−7.5	<.001	N/A
Household income
Below 2× poverty threshold	−4.2	.04	−3.9	.06
Above 2× threshold	Ref		Ref
General health by sex
Female
Excellent/very good/good			Ref
Fair/poor			−4.7	.05
Male
Excellent/very good/good			0.8	.74
Fair/poor			−10.0	<.03