Shared Decision-Making in Mental Health Care - SAMHSA Store ...

52of participation on clinical outcome was indirect, in that adherence mediated the relationshipbetween participation and clinical outcome (Loh, Leonhart, Wills, Simon,& Harter, 2007). At baseline, there were very low levels of consumer involvement indecision-making, based on a sample of 20 audiotaped primary care consultations fordepression treatment (Loh et al., 2006).Other research has also shown that people who experience depression have generallystrong interest in information and participation in decision-making with theirhealth care providers, as well as needs for formal decision support for complex depressiontreatment decisions involving substantial tradeoffs between pros and consof the options (Simon et al., 2007; Wills, 2003; Wills, Franklin, & Holmes-Rovner,2007; Wills & Holmes-Rovner, 2003, 2006). Simon et al. (2007), in a qualitativedescriptive study of 40 persons with depression, found that individuals identifieda need for additional information about depression and its treatment. Wills, in arepresentative sample of 133 people with depression receiving services from a U.S.health maintenance organization, found that these individuals had a variety of needsand preferences for decision support around depression treatment decision-making,including a preference for SDM (Wills, 2003). Stacey et al., in a study of the decisionmakingneeds of people considering depression treatment options, found that relativelyfew people wished to abdicate decision-making to their health care provider ora family member (Stacey et al., under review). In Michigan, in an intervention studyof 32 people with co-occurring depression and diabetes, it was found that exposureto a decision support intervention for depression (support booklet in print or onInternet) was associated with a significant increase in knowledge, decision stage,reduced numbers of depressive symptoms, and lowered stress levels (Wills et al.,2007). However, some research has also documented that people with more severeforms of depression or psychological distress (including lack of insight into illnessand severity) may have lower preferences and capability for digesting informationand for involvement in decision-making (Schneider et al., 2006; Simon et al., 2007;Wills, 2003).Taken together, these studies provide some initial evidence for the interest of personswith depression in information and supportive interventions to aid depressiontreatment decision-making. However, consistent with the conclusion of Levinson etal. based on a national U.S. survey, not all people are equally interested in full partnershipin decision-making, especially those with more severe distress at the time ofdecision-making (Levinson et al., 2005). Almost no information is available on thepreferences of diverse cultural groups that represent views other than mainstreamwhite Western culture. Decision support interventions to promote effective SDMmust be designed and implemented in ways that can back a range of preferences forinvolvement in the informing and deciding process. This type of matching of needsand preferences with interventions does not negate the spirit or intent of fully shareddecision-making and maintains respect for persons in the design and delivery of interventionsand services.Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions