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Author List:
Campbell DG (VA Puget Sound HCS, HSR&D COE, Northwest center for outcomes research in older adults)
Chaney EF (VA Puget Sound HCS, HSR&D COE, Northwest center for outcomes research in older adults)
Yano EM (VA Greater Los Angeles HCS, HSR&D COE for the study of health provider behavior)
Simon BF (VA Greater Los Angeles HCS, HSR&D COE for the study of health provider behavior)
Rubenstein LV (VA Greater Los Angeles HCS, HSR&D COE for the study of health provider behavior)
Bonner LM (VA Puget Sound HCS, HSR&D COE, Northwest center for outcomes research in older adults)
Liu CF (VA Puget Sound HCS, HSR&D COE, Northwest center for outcomes research in older adults)
Simon A (VA Greater Los Angeles HCS, HSR&D COE for the study of health provider behavior)
Objectives:
Depressed patients may or may not expect to improve. Social learning theory predicts that those with low expectations for improvement may be less likely to perform behaviors supporting improvement, such as adhering to treatment recommendations. Whereas evidence-based psychotherapies incorporate activities to raise expectations for recovery, primary care-based patient and clinician education and activation interventions have not specifically targeted these attitudes.
Methods:
Using valid and reliable measures (i.e., PHQ-2 & PHQ-9), we screened approximately 10,633 patients for depression via computer-assisted telephone interviews as part of the WAVES study. Eligible patients attended one of 10 VA primary care clinics dispersed across three VISNs. We asked patients whether they expected their moods to get better, stay the same, or get worse over the next three months. We dichotomized mood improvement expectation to reflect expected improvement versus staying the same or getting worse. We conducted multivariable logistic regression with expectations as the dependent variable. Analyses controlled for demographic factors, symptom severity, and variables significant on bivariate analyses.
Results:
1,890 patients screened positive for depression on the PHQ-2; 1,094 met inclusion criteria and had major depression as assessed by the PHQ-9. 326 refused enrollment or failed to complete the full interview for unknown reasons. 768 enrolled participants comprised the present sample. Participants had a mean age of 60.4+/-11.9 and a mean PHQ-9 of 15.8+/-4.2. In multivariable logistic regression, being older (OR=1.02, 95%CI=1.00-1.03, p=.049) and believing that depression treatment is effective (OR=1.80, 95%CI=1.22-2.64, p=.003) were significantly associated with expectations of mood improvement. Perceived poor health (OR=0.66, 95%CI=0.46-0.94, p=.022) and low social support (OR=0.72, 95%CI=0.60-0.86, p=.000) were associated with negative expectations. Depressive severity was not significant predictor.
Implications:
In accord with theory, patients who believed that depression treatment was effective were more likely to expect improvement. Low social support and poor health were associated with lowered expectations. Future evaluation in this population to determine the relationships between expectations for mood improvement and treatment outcomes is needed.
Impacts:
Future interventions to activate and educate depressed primary care patients with depression may wish to test the effectiveness of incorporating a specific focus on raising patient expectations for future mood improvement.
