Psychosocial factors associated with treatment preference in mental health

Abstract

Background:

Studies examining the effects of incorporating patients’ preferences into treatment outcomes highlight their impact on crucial aspects such as reduced dropout rates and enhanced effectiveness. Recognizing individuals’ rights to participate in decisions about their treatments underscores the importance of studying treatment preferences and the factors influencing these choices.

Aim:

This study aims to identify treatment preferences (psychological, pharmacological, or combined) among a sample of patients and to discern the psychosocial and clinical factors influencing these preferences.

Methods:

A total of 2,133 individuals receiving care at a community mental health unit completed assessments on anxious-depressive symptoms, social and occupational adjustment, and their treatment preference. Data analysis was conducted using SPSS, with descriptive statistics, Chi-square tests, and one-way ANOVA applied.

Results:

Preferences for treatments were distributed as follows: Combined (49.8%), psychological (33%), and pharmacological (10.6%). Factors such as diagnosis, severity of depressive and anxious symptoms, and functional impact were related to treatment preference with a moderate effect size. Meanwhile, various sociodemographic factors correlated with the selected treatment, though with a weak effect size.

Conclusions:

There is a pronounced preference for combined treatments. The significance of psychological treatments is evident, as four out of five participants favored them in their choices. Addressing these preferences calls for an exploration within the broader context of prescription freedom in mental health.

Keywords

Treatment preferences shared decision-making psychological treatment mental health

Introduction

In recent decades, healthcare services have progressively transitioned to a patient-centered approach. This new paradigm emphasizes shared decision-making, a key component of which is the inclusion of patients’ preferences regarding treatment alternatives.

The interest in patient participation in treatments and shared decision-making has been on the rise among the general population, as evidenced by the systematic review conducted by Chewning et al. (2012). Their findings demonstrate an increase in patients’ preference for a shared decision-making role—from 50% in studies conducted before 2000 to 71% in those carried out in subsequent years.

The growing recognition of individuals’ rights to participate in decisions about their treatments, involving informed choices from among various available alternatives, underscores the significance of studying patients’ treatment preferences. This focus extends not only to the potential impact on the treatment itself but also to the factors influencing such choices. In this context, several systematic reviews and meta-analyses (Lindhiem et al., 2014; Preference Collaborative Review Group, 2009; Swift et al., 2011; Swift & Callahan, 2009; Windle et al., 2019) have emphasized the importance of considering preferences about one’s treatments in the health sector, especially in mental health.

Furthermore, the American Psychological Association (APA) has recognized the inclusion of patient preferences as a crucial element of best practice standards since 2006 (APA Presidential Task Force on Evidence-Based Practice, 2006). Similarly, the working group for the Clinical Practice Guideline on Adult Depression Management (2014) strongly advocates for the incorporation of patients’ preferences as an essential step in the decision-making process.

Alongside the right to active participation in one’s own health processes, it is essential to note the findings from studies examining the effects of incorporating stakeholders’ preferences on treatment outcomes. These investigations highlight significant impacts, such as reduced dropout rates and enhanced effectiveness (Lindhiem et al., 2014; McHugh et al., 2013; Swift & Callahan, 2009; Umar et al., 2012; Williams et al., 2016).

Lindhiem et al. (2014) determined in their meta-analysis that providing the preferred treatment correlated with higher satisfaction, improved adherence to treatment, and better outcomes, exhibiting a moderate yet consistent effect size. Consistent with this, certain studies suggest that integrating preferences can influence outcomes by bolstering the therapeutic alliance (Iacoviello et al., 2007; Kwan et al., 2010). Conversely, other researchers have identified a robust link between treatment preferences and adherence to treatment (Dunlop et al., 2017; Gelhorn et al., 2011; Raue et al., 2009).

Swift and Callahan (2009) reviewed studies on the effects of aligning treatments with patient preferences and compared the outcomes across different study designs in their meta-analysis. They discovered an overall effect size of r = .15, p < .001 (CI.95%, 0.09 to 0.21), suggesting that patients matched to their preferred treatment had a 58% likelihood of demonstrating greater improvement. In contrast, those unmatched to their preferences had only a 42% likelihood. Additionally, individuals who received their preferred treatment were considerably less likely to terminate treatments prematurely. Windle et al. (2019), in a meta-analysis centered on psychosocial interventions, determined that obtaining the preferred treatment correlated with a stronger therapeutic alliance and a reduced dropout rate, both pivotal for the effectiveness of treatment.

In mental health, an essential initial decision pertains to the choice between pharmacological and psychological treatments. This choice carries significant implications, not only in terms of time and professional resources associated with each option but also concerning potential medication side effects that patients might endure. Regarding psychological treatments, numerous research findings robustly support various treatment alternatives. These are summarized in many systematic reviews and meta-analyses and are recommended by leading clinical practice guidelines. Furthermore, they are increasingly sought after by various demographic groups.

Several studies have delved into the possible factors influencing one preference over the other (Le et al., 2014; Williams et al., 2016). Given that cultural factors might significantly shape treatment preferences, it is intriguing to explore potential variances across different countries and societal contexts. In Spain, research on treatment preferences in mental health remains limited (Peral Cabrera & Ruisoto Palomera, 2018). It is, therefore, of notable interest to identify the treatment preferences of the population served in mental health services with a view to facilitating the provision of the treatments most demanded by this population.

Patient preference becomes especially salient when multiple equally effective treatments are on offer. This is evident in cases of certain psychological disorders where delivering the preferred treatment could bolster acceptance and adherence while reducing the likelihood of treatment dropout.

The current study seeks to discern preferences among fundamental treatment alternatives—pharmacological, psychological, and combined—in a clinical population from a community mental health unit, and to understand the psychosocial and clinical factors shaping these preferences.

Methodology

Subjects

Initially, the study included 3,191 subjects attended in their first consultation, who were proposed for the evaluation. These are all the patients referred from primary care to the community mental health unit for the first time between 2013 and 2016. Of these, 2,354 (73.8%) completed the various scales, 1,501 women (63.8%) and 853 men (36.2%). The 837 subjects (26.2%) who did not complete them did so for the following reasons: 513 (16%) due to explicit rejection by the subjects, 131 (4.1%) due to comprehension difficulties, 127 (4%) due to psychopathological impossibility, and 66 (2.1%) for other reasons. Out of the total number of people who completed the scales, 221 did not fill in the item about treatment preference, so the final sample consisted of 2,133 participants. Other data on the sociodemographic and clinical characteristics of the subjects who were finally included in the study are presented in Table 1.

Table 1.

Sociodemographic and clinical information (N = 2,133).

	N	%
Sex
°Female	1,357	63.6
°Male	776	36.4
Marital status
°Single	919	43.1
°Married/in a relationship	800	37.5
°Separated/divorced	331	15.5
°Widowed	83	3.9
Educational level
°Incomplete primary school	65	3.0
°Primary School	248	11.6
°Secondary School	244	11.4
°High school diploma/vocational training	770	36.2
°University	806	37.8
Type of coexistence
°Alone	391	18.3
°Own family/partner	991	46.5
°Family of origin	597	28
°Own family and family of origin	19	0.9
°Other relatives or friends	42	2
°Institutions	14	0.7
°Others	79	3.7
Sick leave
°Yes	560	26.3
°No	1,484	69.6
°Not specified	89	4.2
Diagnosis
°Depression	292	13.7
°Anxiety	528	24.8
°Adjustment disorder	740	34.7
°Personality disorder	117	5.5
°Eating disorder	74	3.5
°Psychosis	133	6.2
°Bipolar disorder	38	1.8
°Others	85	4.0
°No pathology	126	5.9

Instruments

Patient Health Questionnaire (PHQ-9; Kroenke et al., 2001)

This questionnaire consists of nine items that evaluate the frequency of depressive symptoms present in the last 2 weeks. Each item is answered on a Likert scale from 0 (‘Never’) to 3 (‘Nearly every day’). The total score is obtained from the sum of all items, with a range from 0 to 27. There is data on its psychometric characteristics in the Spanish primary care population (Muñoz-Navarro et al., 2017) and in the hospital population (Diez-Quevedo et al., 2001). The internal consistency of the scale in the current sample is very satisfactory (Cronbach’s Alpha of .86).

Generalized Anxiety Disorder-7 Scale (GAD-7; Spitzer et al., 2006)

It consists of seven items, referring to the last 2 weeks, and measures the severity of various anxiety symptoms on a four-point scale ranging from 0 (‘Not at all’) to 3 (‘Nearly every day’). The total score is obtained by adding the seven items, where a higher score represents greater severity. Several studies have confirmed its suitable psychometric characteristics (García-Campayo et al., 2010; Löwe et al., 2008). The consistency of the scale in the current sample is very satisfactory (Cronbach’s Alpha of .87).

Work and Social Adjustment Scale (WSAS; Mundt et al., 2002)

This is a self-report scale that assesses functional impairment attributable to an identified mental health problem. It consists of five items scored on a scale from 0 to 8, where 0 indicates no impairment and eight indicates very severe impairment. The sum of the scores obtained in each of the five items provides a total score of the degree of functional impairment. The data obtained both in the original English version and in the Spanish adaptation show suitable validity and reliability (Mundt et al., 2002; Vázquez Morejón et al., 2021). In the current sample, Cronbach’s Alpha also confirms high consistency with a score of .85.

Ad hoc questionnaire

In relation to treatment preference, an additional item was included with four response options and written as follows: ‘The treatment you believe you need is’: (1) None, (2) Pharmacological, (3) Psychological, (4) Both, psychological, and pharmacological.

Procedure

All patients attending a first consultation at a community mental health unit who met the inclusion criteria were offered a first evaluation with the previously mentioned instruments. These are subjects who have been referred by primary care family medicine to specialized mental health services. This study is part of a broader project on emotional disorders and predictive factors carried out based on routine evaluations conducted in individuals attending a community mental health unit for the first time (project approved by the Ethics Committee with the code 0934-N-18). In all cases, their informed consent for participation in the study was requested. Diagnosis was made following the ICD-10 criteria by clinical psychology or psychiatry specialists after a clinical interview collecting their clinical history and psychopathological examination.

The Work and Social Adjustment Scale (WSAS) was included at a later stage, so it was only completed by 503 subjects. Subsequently, data were computerized and analyzed using the SPSS v22 software package.

Data analysis

Descriptive statistics were calculated for quantitative variables and frequency distribution for qualitative variables. To explore differences between included and excluded subjects, the T-test for independent groups was used for comparison of quantitative variables, and the Chi-square test was used for qualitative variables. For comparing means in variables with two or more subgroups, ANOVA was used, while Pearson’s correlation was used to explore correlations between quantitative variables.

Results

Differences between included and excluded participants

Possible differences between those included and excluded were explored regarding age, sex, education level, and marital status. Participants showed an average age of 43.9 years compared to 52.9 years for non-participants (t = 12.96, df = 1234.7; p < .001). As for sex, differences are observed with a small (28.7% vs. 24.7%) but significant (Chi-square 6.229; df: 1; p = .130) greater refusal on the part of men. The education level also shows significant differences, with a greater number of people participating as the education level increases (Chi-square 200.512; df: 7; p < .001), going from 62.2% in people with primary studies to 82.4% in people with university studies. On the other hand, concerning marital status, significant differences are observed (Chi-square 105.195; df: four; p < .001) with greater participation in the case of single people (78.9%) and lesser participation in widowed people (45%). That is, slightly more female people, younger, single, and with a higher education level are included in the participating group.

However, it should be noted that the effect size of this relationship is weak in sex (Cramer’s V = 0.04) and marital status (Cramer’s V = 0.18) and moderate regarding education level (Cramer’s V = 0.03) and age (d = 0.56).

Treatment preferences

The distribution of the 2,133 participants who answered the question about their treatment preference is shown in Table 2. Of the 2,354 subjects included, 221 (9.4%), although they completed the various scales, did not respond to the specific item related to treatment preference.

Table 2.

Total and sex-specific treatment preferences (N = 2,133).

Type of treatment	Female		Male		Total
Type of treatment	N	%	N	%	N	%
None	80	5.9	60	7.7	140	6.6
Psychological	475	35	229	29.5	704	33
Pharmacological	119	8.8	108	13.9	227	10.6
Combined (psychological and pharmacological)	683	50.3	379	48.8	1.062	49.8

The preferred type of treatment is, firstly, the combined (psychological and pharmacological) with almost five out of every 10 people considering this combination as the treatment they need. Secondly, the preferred treatment is psychological treatment, considered as the only treatment needed by 1 in 3 people. Thirdly, pharmacological treatment, as the only treatment, is preferred by 1 in every 10 people. Lastly, it is worth noting a smaller number of subjects who consider that they do not require any treatment.

Preferences and sociodemographic variables

As for sex, the results (Table 2) show very significant differences in terms of treatment preferences, with a greater preference in the case of women for psychological treatments and combined treatments (Chi-square 19.566; df = 3; p < .001), while men, although preferences maintain the same order, show a slight but significant greater preference than women for pharmacological treatments.

Age also appears to be related to the preferred type of treatment (Anova F = 48.723; df = 3; p < .001), with a higher age of people who prefer only pharmacological treatment (M = 50.31 years), slightly younger in those who choose combined treatment (M = 45.49 years), and the youngest of those who prefer psychological treatment (M = 39.23 years).

By age intervals, this relationship is evidenced (Chi-square 160.548; df = 6; p < .001) with an increase in preference for psychological treatments as age decreases, going from 22.5%, to 27.6%, and to 46.8%, corresponding to the three age intervals (<36, 36-65 and >65 years). In the case of pharmacological treatments, on the contrary, a tendency toward an increase in preference is observed as one moves from the first interval (<36 years), with 6.9% of subjects with a preference for psychological treatments, to a second interval (36–65 years), with 10.8%, and a third (>65 years), with 26.1%.

Marital status, on the other hand, appears to be significantly associated with the preferred type of treatment (Chi-square 42.068; df = 12; p < .001), with a greater preference for psychological treatments among single people (39%) and widows (33.8%), and somewhat lower among married (27.6%) and separated/divorced individuals (28.6%). Similarly, educational level shows a correlation with preferred types of treatment (Chi-square = 47.50; df = 21; p < .005) with a greater preference for psychological treatments as educational level increases.

Likewise, employment status shows a significant relationship with the preferred type of treatment (Chi-square = 112.878; df = 15, p < .001). While students double the number of pensioners in their preference for psychological treatments (49.1%vs. 20.7%), pensioners and homemakers triple the number of students in terms of preference for pharmacological treatments (18% and 19.6% vs. 5.5% respectively).

The situation of being on leave presents, on the other hand, a significant relationship with treatment preference (Chi-square = 57.741, df = 3, p < .001), especially showing a decrease in the number of subjects who prefer psychological treatment (24% in the group on leave vs. 36% in the group not on leave), as well as an increase in subjects who prefer a combined treatment (63% in the people on leave vs. 45% in those not on leave).

The effect size of the association with treatment preference is moderate in the case of age (eta squared = 0.06) and weak in the rest of the sociodemographic variables (ranging between .08 and .16 in the Cramer’s V for marital status and being on leave respectively).

Preferences and clinical variables

Diagnosis. There is a significant relationship between treatment preference and diagnosis (Chi-square = 282.038; df = 39; p < .001). Most diagnostic groups show the same preference order (combined, psychological, and pharmacological), albeit with two exceptions: first, people with eating disorders, in which the most preferred treatment is psychological, followed by combined, with no consideration for pharmacological treatment as the sole treatment. Secondly, bipolar disorder, in which the preferred treatment is combined, followed by pharmacological and lastly psychological (see Table 3). It is of interest to highlight that one in four people with psychosis prefers psychological treatment as the only treatment alternative.

Table 3.

Treatment preferences by diagnostic groups (N = 2,133).

Diagnosis	Type of preference
	None		Pharmacological		Psychological		Combined
	N	%	N	%	N	%	N	%
Psychosis	15	11.3	23	17.3	31	23.3	64	48.1
Bipolar disorder	1	2.6	9	23.7	4	10.5	24	63.2
Depression	5	1.7	29	9.9	77	26.4	181	62
Anxiety-somatization	16	3	60	11.4	167	31.6	285	54
Eating disorders	4	5.4	0	0	37	50	33	44.6
Personality disorder	6	5.1	7	6	37	31.6	67	57.3
Adjustment disorders	43	5.8	70	9.5	282	38.1	345	46.6
No pathology	43	33.7	14	10.9	49	37.8	23	17.6
Others	10	12.3	17	20.6	21	26	34	41.1

Intensity of symptoms, functional impact, and years of evolution

The intensity of depressive and anxious symptoms, evaluated with the PHQ-9 and GAD-7 scales respectively, shows a significant relationship with the preference for one treatment or another (Table 4). As the intensity increases, there is a shift from preference for pharmacological, psychological, and combined treatment, respectively.

Table 4.

Severity of symptoms and treatment preference (N = 2,133).

Scale	None N = 140		Pharmacological N = 227		Psychological N = 704		Combined N = 1,062		ANOVA
Scale	M	d.t.	M	d.t.	M	d.t.	M	d.t.	F	d.f.	p
PHQ-9	9.11	5.81	12.62	6.61	13.97	5.67	16.24	6.12	75.93	3	<.001
GAD-7	7.38	4.97	10.54	5.37	11.68	4.89	13.03	4.97	62.43	3	<.001
WSAS	9.74	8.98	15.72	11.77	18.56	9.66	22.28	9.76	21.62	3	<.001
Years of evolution	5.60	9.49	12.92	14.29	8.97	10.47	13.13	12.88	20.55	3	<.001

On the other hand, differences are also observed in the preferred treatment according to the functional impact assessed by the WSAS. As the impact increases, a progression, similar to that detected in symptom intensity is observed (Table 4).

Regarding the years of evolution, significant differences are found in the chosen treatments. Participants with a shorter duration of symptoms prefer psychological treatment and those with more years of evolution indicate a preference for pharmacological or combined treatment (Table 4).

The effect size of the relationship of clinical variables with treatment preference is moderate in the case of diagnosis (Cramer’s V = 0.35), depressive symptoms evaluated by the PHQ-9 (eta squared = 0.10), and anxious symptoms evaluated using the GAD-7 (eta squared = 0.08), previous treatments (Cramer’s V = 0.31), and the impact on social adjustment evaluated using the WSAS (eta squared = 0.11). Only in the case of years of evolution is a weak effect size observed, although it is close to moderate (eta squared = 0.035).

Discussion

An initial global analysis of the results allows us to assert that different treatment alternatives have very different preference percentages. The order of preference shows combined treatment as the first choice (49.8%), followed by psychological treatment (33%) and lastly pharmacological treatment (10.6%).

Churchill et al. (2000) found that 50.8% of participants showed a preference for psychological interventions, in contrast to the 15.3% who favored pharmacological ones. This proportion is very close to that observed in the meta-analysis by McHugh et al. (2013), where participants showed three times more preference for psychological treatments than for pharmacological ones, both in depression and in anxiety, a proportion identical to that obtained in the present study.

These results are also consistent with what has been observed in various studies where a wide acceptance of combined treatments is found and a greater preference for psychological treatments over medication in samples of people with depression (Peral Cabrera & Ruisoto Palomera, 2018; Winter & Barber, 2013). Similarly, these preferences largely correspond with the recommendations made by Furukawa et al. (2021), based on their network meta-analysis on the effectiveness of treatments for depression. Moreover, they also coincide with the results of various studies in terms of a greater preference for psychological treatments in relation to pharmacological treatments in various disorders (Dorow et al., 2018; Dunlop et al., 2012; Hanson et al., 2016; Mohlman, 2012; Valencia Agudo et al., 2015).

This proportion is also repeated in studies of specific psychological treatments (Deacon & Abramowitz, 2005), who found that the preference for a specific psychological treatment (cognitive-behavioral therapy), in relation to a pharmacological treatment, is 3 to 1.

Regarding the variables related to preferences, the results reveal a significant relationship between treatment preferences and various sociodemographic variables such as sex, age, marital status, educational level, and employment status.

A greater preference for psychological treatments is observed in women, which is in line with the findings in the meta-analysis by McHugh et al. (2013), who also find women as the group most likely to prefer psychological treatments. Likewise, Peral Cabrera and Ruisoto Palomera (2018) find greater preferences for psychological treatments in women, especially among the younger ones. Although men also prefer psychological treatments over pharmacological ones (Sierra Hernandez et al., 2014) various studies find a slightly higher acceptance of pharmacological treatments in men (Burg et al., 2011; Liddon et al., 2018; Peral Cabrera & Ruisoto Palomera, 2018). Gender roles could play a role in these preferences, resulting in a lower tendency in men to address their emotional problems (Liddon et al., 2018).

On the other hand, it is worth noting the greater preference for psychological treatments observed in younger people, which coincides with the findings of McHugh et al. (2013). In the same vein, Dorow et al. (2018) find that age and educational level are the main variables associated with treatment preference, with younger people and those with higher education showing a greater preference for psychological treatments. Shepardson et al. (2021) also identify educational level as a variable associated with treatment preference. It can be thought that with a lower educational level, there may be less knowledge about psychological alternatives and their characteristics. In this sense, some authors (Juntunen et al., 2022; Zimmerman et al., 2020) have drawn attention to the need to adapt psychological treatments to people with fewer resources, highlighting that in many cases the design of these treatments is tailored to people with a higher level of education, which makes access to these treatments difficult for people with these characteristics.

In general terms, the results show that the profile of those who believe that they only need pharmacological treatment tends to be male, older, and with a lower level of education.

With regard to the clinical factors associated with preference, it is worth noting that most diagnostic groups present the same sequence in terms of treatment preference: combined, psychological, and pharmacological, with the exception of: (1) the diagnosis of eating disorders, in which only psychological treatment is considered as the first preference and combined as the second, with pharmacological treatment not contemplated as a treatment preference in any case, and (2) people diagnosed with bipolar affective disorder, who show preference first for combined treatment and second for pharmacological, with less preference for psychological treatment as the only treatment. In other words, this group appears to be the most likely to consider pharmacological treatment as the only treatment, which could be closely related to beliefs about the biological causes of the disorder. Moreover, it is interesting to note the significant proportion of people diagnosed with psychosis, 1 in 4, who express their preference for psychological treatments as the only treatment alternative, which contrasts with the usual practice of generalized indication of pharmacological treatment as the first and sometimes the only alternative. Considering the recommendations of the NICE Guide for psychosis (2014), which recommends including psychological treatment in the first episodes and in relapse periods, as well as the significant adherence problem of this population, it would be of great interest to guarantee early access to these psychological treatments for their acceptance and usefulness, and as a first contact that can facilitate adherence with the therapeutic team.

On the other hand, it is of interest to note that the greater severity of symptoms appears to be associated with an increase in preference for combined treatments. As Peral Cabrera and Ruisoto Palomera (2018 point out, in more severe cases, the preference for combined treatments may be due to the belief that two treatments can be more effective than one alone. In any case, at least in the case of depression, this preference seems consistent with the recommendations of the NICE Guide for the treatment of depression (2022).

Regarding the years of evolution, it is noteworthy that patients with less time of evolution prefer psychological treatments, while pharmacological treatment is chosen in patients with greater chronicity. It must not be forgotten that, in order to be attended to in mental health units, patients must first go through primary care, a setting in which, due to lack of resources, the most common approach is pharmacological treatment. This leads to a high percentage of people referred to mental health already presenting with prescribed pharmacological treatment. The longer the time of evolution, the higher the likelihood of having started pharmacological treatment. In the early years of evolution and among younger subjects, there is a tendency to consider psychological treatment as more appropriate. This highlights the need to offer psychological treatments earlier, which are more accepted in the early years and are more likely to impact outcomes.

Regarding the limitations of the study, it is necessary to point out the percentage of subjects not included for various reasons (rejection, impossibility, etc.). Possible differences between those included and not included in the study can imply biases that must be taken into account when interpreting the results. However, it should be noted that this percentage of rejections is similar to that observed in various studies (Lang, 2005; Wetherell et al., 2004), in which rejection rates of around 40% are observed. It is also important to note that this is a population attended to in mental health services, whose preferences may vary from the general population and the population attended to in primary care centers.

Regarding future lines of research, it would be important to conduct new studies in larger and more diverse samples, especially considering the significance of various sociodemographic variables when choosing between different therapeutic alternatives. In this sense, it would be interesting to explore preferences in a sample of the general population or in samples of the population attended to in primary care services. Furthermore, it would be interesting to explore, as various authors suggest, potential differences in the benefits of considering treatment preferences in different diagnostic groups (Lindhiem et al., 2014; Mott et al., 2015) and in various specific groups (Wetherell et al., 2004), such as young people (Benjet et al., 2020) or women in the perinatal period (Hadfield et al., 2019; Westgate et al., 2023).

In turn, it is of interest to consider more specific aspects, such as treatment intensity, face-to-face versus virtual modality, or individual versus group settings, in line with the approach of Lokkerbol et al. (2019).

To summarize, beyond the inherent value of respecting individual rights to be actively involved in health-related decisions, recognizing treatment preferences holds significant relevance given its influence on adherence, satisfaction, and overall treatment outcomes (Lindhiem et al., 2014; McHugh et al., 2013; Umar et al., 2012; Williams et al., 2016).

Within mental health care, the inclination toward pharmacological treatments is deeply entrenched, largely because prevailing health practices often shape expectations wherein medication is seen as the primary solution within the biomedical model. Nonetheless, the data strongly underscores the necessity of meeting the demand for psychological interventions: five out of six individuals express a desire for psychological therapy, half in conjunction with medication. Notably, a third prefers it as the exclusive mode of treatment.

Consequently, a pressing challenge for public health services lies in ensuring this freedom of choice, emphasizing the delivery of psychological treatments at the frequency and intensity recommended by clinical practice guidelines, thereby ensuring the quality and efficacy of these interventions.

Footnotes

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Manuel Alejandro Muñoz Caracuel

Raquel Vázquez-Morejón

Ethics approval statement

The study was approved by the Andalusian Biomedical Research Ethics Committee under the code no. 0934-N-18

Data availability statement

Research data are not share

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