Depression Derails Truthful Talk to Physicians

PARIS – Eliciting truthful dialogue from patients with depression may be as elusive as a simple cure for the condition.

A large Internet-based survey involving 2,020 patients who had received treatment for depression within the past year found that a full 70.2% had lied, at least once, during treatment.

More than two-thirds, or 69%, fibbed about daily activities such as work, while 52.6% failed, on purpose, to accurately report their symptoms, Dr. Norifusa Sawada reported at the annual meeting of the European College of Neuropsychopharmacology.

"The fact that more than 70% of patients with depression do not disclose the truth emphasizes the need for clinical suspicion, as well as more objective assessment of their symptoms and medication adherence," he suggested.

Men were significantly more likely than women to be dishonest about daily activities and intake of alcohol and illicit drugs.

In contrast, women were more likely to be dishonest about adherence to prescribed medication and data such as body temperature and weight.

The most frequent (49%) reason why patients didn’t tell the truth was because they found it difficult to talk to their doctor, reported Dr. Sawada, a psychiatrist at Keio University in Toyko. In all, 30% of Japanese patients said they were embarrassed to tell the truth. A disconcerting 36.5%, however, failed to tell the truth because "I thought my doctor would not take it seriously, even if I told him or her."

Female patients were significantly more likely than males to cite this reason, but also said they were less than frank about the truth because they could not trust their doctor or their doctor looked busy.

In contrast, men were significantly more likely to report they didn’t tell the truth because of concerns that their physician would recommend they take sick leave or quit their job.

Logistic regression analysis found significant associations between not telling the truth and lower satisfaction in communication with their physicians (odds ratio, 1.98 for not satisfied and OR, 2.78 for dissatisfied; P value less than .001 for both).

Other significant predictors were female sex (OR, 1.54, P less than .001) and younger age (20-29 years vs. 50-59 years OR, 0.65, P = .004; 20-29 years vs. 60-69 years, OR, 0.29, P = .027). Physician age and gender, and patient income had no effect.

All patients, aged 20-69 years, had received treatment within the past year for a diagnosis of major depressive disorder by a psychiatrist. None had bipolar, and all were registered with Macromill, one of the largest online research companies in Japan.

In all, 32% of patients reported quitting treatment for depression without consulting their physician, and 45% discontinued antidepressants without consultation, Dr. Sawada noted.

The researchers previously reported that only 44% of 367 outpatients with major depressive disorder continued their antidepressants for 6 months (BMC Psychiatry 2009;9:38).

In the current analysis, the most common reason patients gave for discontinuing treatment was that their symptoms got better, followed by, "I did not get along with my doctor," and that they could not or did not want to go out.

"When communication between patients and their physician is suboptimal, patient status and behavior should be monitored with more objective vigilance in an effort to avoid undesirable premature withdrawal from antidepressants." This also underscores the importance of a good patient-physician alliance to gather relevant information toward a successful treatment, Dr. Sawada said.

Pfizer sponsored the study. The authors report no conflicts.

PARIS – Eliciting truthful dialogue from patients with depression may be as elusive as a simple cure for the condition.

A large Internet-based survey involving 2,020 patients who had received treatment for depression within the past year found that a full 70.2% had lied, at least once, during treatment.

More than two-thirds, or 69%, fibbed about daily activities such as work, while 52.6% failed, on purpose, to accurately report their symptoms, Dr. Norifusa Sawada reported at the annual meeting of the European College of Neuropsychopharmacology.

"The fact that more than 70% of patients with depression do not disclose the truth emphasizes the need for clinical suspicion, as well as more objective assessment of their symptoms and medication adherence," he suggested.

Men were significantly more likely than women to be dishonest about daily activities and intake of alcohol and illicit drugs.

In contrast, women were more likely to be dishonest about adherence to prescribed medication and data such as body temperature and weight.

The most frequent (49%) reason why patients didn’t tell the truth was because they found it difficult to talk to their doctor, reported Dr. Sawada, a psychiatrist at Keio University in Toyko. In all, 30% of Japanese patients said they were embarrassed to tell the truth. A disconcerting 36.5%, however, failed to tell the truth because "I thought my doctor would not take it seriously, even if I told him or her."

Female patients were significantly more likely than males to cite this reason, but also said they were less than frank about the truth because they could not trust their doctor or their doctor looked busy.

In contrast, men were significantly more likely to report they didn’t tell the truth because of concerns that their physician would recommend they take sick leave or quit their job.

Logistic regression analysis found significant associations between not telling the truth and lower satisfaction in communication with their physicians (odds ratio, 1.98 for not satisfied and OR, 2.78 for dissatisfied; P value less than .001 for both).

Other significant predictors were female sex (OR, 1.54, P less than .001) and younger age (20-29 years vs. 50-59 years OR, 0.65, P = .004; 20-29 years vs. 60-69 years, OR, 0.29, P = .027). Physician age and gender, and patient income had no effect.

All patients, aged 20-69 years, had received treatment within the past year for a diagnosis of major depressive disorder by a psychiatrist. None had bipolar, and all were registered with Macromill, one of the largest online research companies in Japan.

In all, 32% of patients reported quitting treatment for depression without consulting their physician, and 45% discontinued antidepressants without consultation, Dr. Sawada noted.

The researchers previously reported that only 44% of 367 outpatients with major depressive disorder continued their antidepressants for 6 months (BMC Psychiatry 2009;9:38).

In the current analysis, the most common reason patients gave for discontinuing treatment was that their symptoms got better, followed by, "I did not get along with my doctor," and that they could not or did not want to go out.

"When communication between patients and their physician is suboptimal, patient status and behavior should be monitored with more objective vigilance in an effort to avoid undesirable premature withdrawal from antidepressants." This also underscores the importance of a good patient-physician alliance to gather relevant information toward a successful treatment, Dr. Sawada said.

Pfizer sponsored the study. The authors report no conflicts.

PARIS – Eliciting truthful dialogue from patients with depression may be as elusive as a simple cure for the condition.

A large Internet-based survey involving 2,020 patients who had received treatment for depression within the past year found that a full 70.2% had lied, at least once, during treatment.

More than two-thirds, or 69%, fibbed about daily activities such as work, while 52.6% failed, on purpose, to accurately report their symptoms, Dr. Norifusa Sawada reported at the annual meeting of the European College of Neuropsychopharmacology.

"The fact that more than 70% of patients with depression do not disclose the truth emphasizes the need for clinical suspicion, as well as more objective assessment of their symptoms and medication adherence," he suggested.

Men were significantly more likely than women to be dishonest about daily activities and intake of alcohol and illicit drugs.

In contrast, women were more likely to be dishonest about adherence to prescribed medication and data such as body temperature and weight.

The most frequent (49%) reason why patients didn’t tell the truth was because they found it difficult to talk to their doctor, reported Dr. Sawada, a psychiatrist at Keio University in Toyko. In all, 30% of Japanese patients said they were embarrassed to tell the truth. A disconcerting 36.5%, however, failed to tell the truth because "I thought my doctor would not take it seriously, even if I told him or her."

Female patients were significantly more likely than males to cite this reason, but also said they were less than frank about the truth because they could not trust their doctor or their doctor looked busy.

In contrast, men were significantly more likely to report they didn’t tell the truth because of concerns that their physician would recommend they take sick leave or quit their job.

Logistic regression analysis found significant associations between not telling the truth and lower satisfaction in communication with their physicians (odds ratio, 1.98 for not satisfied and OR, 2.78 for dissatisfied; P value less than .001 for both).

Other significant predictors were female sex (OR, 1.54, P less than .001) and younger age (20-29 years vs. 50-59 years OR, 0.65, P = .004; 20-29 years vs. 60-69 years, OR, 0.29, P = .027). Physician age and gender, and patient income had no effect.

All patients, aged 20-69 years, had received treatment within the past year for a diagnosis of major depressive disorder by a psychiatrist. None had bipolar, and all were registered with Macromill, one of the largest online research companies in Japan.

In all, 32% of patients reported quitting treatment for depression without consulting their physician, and 45% discontinued antidepressants without consultation, Dr. Sawada noted.

The researchers previously reported that only 44% of 367 outpatients with major depressive disorder continued their antidepressants for 6 months (BMC Psychiatry 2009;9:38).

In the current analysis, the most common reason patients gave for discontinuing treatment was that their symptoms got better, followed by, "I did not get along with my doctor," and that they could not or did not want to go out.

"When communication between patients and their physician is suboptimal, patient status and behavior should be monitored with more objective vigilance in an effort to avoid undesirable premature withdrawal from antidepressants." This also underscores the importance of a good patient-physician alliance to gather relevant information toward a successful treatment, Dr. Sawada said.

Pfizer sponsored the study. The authors report no conflicts.