Self-stigmatization and treatment preferences: Measuring the impact of treatment labels on choices for depression medications.

Objective: To collect evidence on the possibility that patients with depression experience self-stigmatization based on label information for medications.
Methods: We developed a discrete-choice experiment (DCE) survey instrument that asked respondents to make choices between hypothetical treatments for major depressive disorder (MDD). We also included treatment type (antidepressants versus antipsychotics) and approved indications for the medication. The choice questions mimicked the information presented in product inserts and required systematic tradeoffs between treatment efficacy, treatment type, and indication. We calculated how many patients were willing to forgo efficacy to avoid treatments with information associated with self-stigmatization, and how much efficacy they were willing to forgo. We also evaluated the impact of contextualizing the treatment information to reduce self-stigmatization by randomizing respondents who received additional context.
Results: A total of 501 patients with MDD were recruited to complete the DCE survey. Respondents had well-defined preferences for treatment outcomes. Over 60% (63.4%) of respondents were found to be significantly affected by treatment indication. These respondents were willing to forgo about 2.5 percentage points in the chance of treatment efficacy to avoid treatments indicated for schizophrenia. We also find that some level of contextualization of the treatment details could help reduce the negative impact of treatment type and indications.
Conclusions: Product-label treatment indication can potentially lead to patient self-stigmatization as shown by patients' avoidance of treatments that are also used to treat schizophrenia. While the effect appears to be relatively small, results suggests that the issue is likely pervasive.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: HCW and MB are employees of Otsuka Pharmaceutical Development & Commercialization, Inc. JMGS, RJ, and MW are employees of Duke Clinical Research Institute, which received funding to conduct this study. MT received compensation from Otsuka Pharmaceutical Development & Commercialization, Inc. for his review of the protocol and interpretation of the data for this study. This does not alter our adherence to PLOS ONE policies on sharing data and materials
(Copyright: © 2024 Gonzalez Sepulveda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)