Patient preferences for a guided self-help programme to prevent relapse in anxiety or depression: A discrete choice experiment.

Anna D T Muntingh,Anton J L M Van Balkom,Annemieke Van Straten,Elly A Stolk,Neeltje M Batelaan,Digna J F Van Schaik,Adriaan W Hoogendoorn,Hedwig Eisenbarth

doi:10.1371/journal.pone.0219588

Abstract

BackgroundAnxiety and depressive disorders are increasingly being viewed as chronic conditions with fluctuating symptom levels. Relapse prevention programmes are needed to increase self-management and prevent relapse. Fine-tuning relapse prevention programmes to the needs of patients may increase uptake and effectiveness.Materials and methodsA discrete choice experiment (DCE) was conducted amongst patients with a partially or fully remitted anxiety or depressive disorder. Patients were presented 20 choice tasks with two hypothetical treatment scenarios for relapse prevention, plus a “no treatment” option. Each treatment scenario was based on seven attributes of a hypothetical but realistic relapse prevention programme. Attributes considered professional contact frequency, treatment type, delivery mode, programme flexibility, a personal relapse prevention plan, time investment and effectiveness. Choice models were estimated to analyse the data.ResultsA total of 109 patients with a partially or fully remitted anxiety or depressive disorder completed the DCE. Attributes with the strongest impact on choice were high effectiveness, regular contact with a professional, low time investment and the inclusion of a personal prevention plan. A high heterogeneity in preferences was observed, related to both clinical and demographic characteristics: for example, a higher number of previous treatment episodes was related to a preference for a higher frequency of contact with a professional, while younger age was related to a stronger preference for high effectiveness.ConclusionsThis study using a DCE provides insights into preferences for a relapse prevention programme for anxiety and depressive disorders that can be used to guide the development of such a programme.

Highlights

Anxiety and depressive disorders are highly prevalent and often comorbid conditions, in which relapse, recurrence and chronicity are common [1,2]
A high heterogeneity in preferences was observed, related to both clinical and demographic characteristics: for example, a higher number of previous treatment episodes was related to a preference for a higher frequency of contact with a professional, while younger age was related to a stronger preference for high effectiveness
This study using a discrete choice experiment (DCE) provides insights into preferences for a relapse prevention programme for anxiety and depressive disorders that can be used to guide the development of such a programme

Summary

Introduction

Anxiety and depressive disorders are highly prevalent and often comorbid conditions, in which relapse, recurrence and chronicity are common [1,2]. For patients with a major depressive disorder, this figure is 38% [4] These numbers rise sharply when the incidence of an anxiety or depressive disorder other than the index disorder is counted as relapse. This means that the majority (57%) of adults who remit from an anxiety or depressive disorder experience a recurrence of the index disorder or another anxiety or depressive disorder within four years after recovery [4]. Fine-tuning relapse prevention programmes to the needs of patients may increase uptake and effectiveness.

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Conclusion