Adults who received their preferred psychosocial mental health treatment were less likely to drop out of treatment and more likely to report therapeutic alliance, according to an article published in JAMA Psychiatry. In contrast with previous studies, investigators found no evidence of a significant association between treatment preference and clinical outcomes.

Emma Windle, MA, of the Unit for Social and Community Psychiatry at Queen Mary University of London, United Kingdom, and colleagues performed a systematic review and meta-analysis of studies from several databases published from inception to July 20, 2018. Studies of interest focused on mental health, patient preference, and psychosocial interventions. The researchers pooled data using a random-effects model and assessed risk of bias using the Cochrane Risk of Bias Tool, version 2.

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The investigators identified 29 randomized controlled trials with 5294 total participants aged over 18 years with a mental health diagnosis, primarily depression or anxiety. For participants matched with a preferred psychosocial treatment, there were significantly lower dropout rates (pooled risk ratio, 0.62; 95% CI, 0.48-0.80; P <.001; I2, 44.6%) and a stronger therapeutic alliance (Cohen d, 0.48; 95% CI, 0.15-0.82; P =.01; I2, 20.4%). However, the study found no significant association with mean treatment session attendance, improved depression and anxiety symptoms, global outcomes, treatment satisfaction, or clinical remission rates.

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Study limitations included significant heterogeneity among the studies, which may have influenced comparability between respondents. Several of the studies were conducted in the United States and among participants with depression, potentially affecting generalizability. However, the researchers found little evidence of publication bias in sensitivity analysis. Future research should include outcomes from countries with varied health care systems and participants with a wider range of diagnoses.

“Even if the range of available psychosocial interventions is limited within services,” the investigators noted, “this study suggests that offering a basic level of choice (eg, medication or psychotherapy) can be beneficial to both patients with mental health diagnoses and mental health services.”


Windle E, Tee H, Sabitova A, Jovanovic N, Priebe S, Carr C. Association of patient treatment preference with dropout and clinical outcomes in adult psychosocial mental health interventions: a systematic review and meta-analysis [published online December 4, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.3750