Are Veterans Getting Their Preferred Depression Treatment? A National Observational Study in the Veterans Health Administration

Background Physician responsiveness to patient preferences for depression treatment may improve treatment adherence and clinical outcomes. Objective To examine associations of patient treatment preferences with types of depression treatment received and treatment adherence among Veterans initiating depression treatment. Design Patient self-report surveys at treatment initiation linked to medical records. Setting Veterans Health Administration (VA) clinics nationally, 2018-2020. Participants A total of 2582 patients (76.7% male, mean age 48.7 years, 62.3% Non-Hispanic White) MAIN MEASURES: Patient self-reported preferences for medication and psychotherapy on 0-10 self-anchoring visual analog scales (0="completely unwilling"; 10="completely willing"). Treatment receipt and adherence (refilling medications; attending 3+ psychotherapy sessions) over 3 months. Logistic regression models controlled for socio-demographics and geographic variables. Key results More patients reported strong preferences (10/10) for psychotherapy than medication (51.2% versus 36.7%, McNemar χ21=175.3, p Conclusions Mismatches between treatment preferences and treatment type received were common and associated with worse treatment adherence for psychotherapy. Future research could examine ways to decrease mismatch between patient preferences and treatments received and potential effects on patient outcomes.