Preferences for depression treatment and the role of health literacy

There is an increasing interest in understanding people’s preferences for depression treatment in Australia. While several treatments are available, individuals are underutilising them. The objective of this study was to elicit treatment preferences for people who have been diagnosed with depression in the past five years, and explore whether health literacy played a role in treatment preferences.

A total of 1,015 Australian individuals completed an online survey which included a Discrete Choice Experiment (DCE). Individuals chose repetitively between hypothetical depression treatments that varied in six attributes: treatment type, cost, effectiveness, side-effects, number of visits and waiting time. Health literacy was measured using a validated, multidimensional tool called the Health Literacy Questionnaire (HLQ). Data were first analysed using a conditional logit model, followed by a mixed logit model to account for observed and unobserved heterogeneity. Relative importance and willingness to pay (WTP) of treatment attributes were estimated.

Results suggest that treatment cost, effectiveness and side-effects are the most important predictors of choice. Individuals are willing to pay substantial amounts to avoid treatments that cause sexual side-effects, gastrointestinal side-effects and weight gain. Significant preference heterogeneity was observed, and subgroup analyses suggested that these differences are partially driven by health literacy patterns and gender. Variation in preferences was also observed between people who are currently receiving treatment and people who were diagnosed with depression but aren’t currently receiving treatment.

Our findings provide useful information about individuals’ treatment preferences, the factors associated with these preferences and health literacy strengths and weaknesses for people diagnosed with depression. This study provides useful inputs for health care providers and policy makers to better understand issues that need to be addressed for better mental health outcomes.