Associations of perceived helpfulness of depression treatment modality with symptom severity and substance use disorder.

backgroundMental health treatment use remains low despite increasing major depressive episodes (MDE), suicidality, and substance use disorders (SUD).

aimsTo examine the associations of perceived treatment helpfulness with clinical characteristics (MDE, suicidality, and SUD) and treatment modality (medication, counseling/other treatment [COT], and both treatment [MCOT]).

methodsWe used the 2022 and 2023 U.S. National Survey on Drug Use and Health data on adult depression treatment users (N = 10,221) and multinomial and generalized ordinal logistic regression models.

resultsAmong treatment users, 15% used medication only, 25% used COT only, and 60% used MCOT. Overall, 60% of medication users and 47% of COT users perceived their respective treatments as “a lot” or “extremely” helpful. MDE and suicidality were associated with a higher likelihood of using COT only and/or MCOT. Both MDE and suicidality were associated with lower odds of perceiving treatment as helpful among medication users (OR =  0.47, 95% CI = 0.39–0.57 for MDE; OR =  0.78, 95% CI  =  0.66–0.91 for suicidality) as well as COT users (OR  = 0.67, 95% CI =  0.56–0.80 for MDE; OR =  0.82, 95% CI  = 0.70–0.97 for suicidality). Co-occurring alcohol and drug use disorders were also associated with lower odds of perceived helpfulness among COT users. The use of both medication and COT was associated with higher odds of perceiving either modality as helpful. These patterns did not differ meaningfully for individuals with MDE.

conclusionsThe lower perceived treatment helpfulness among individuals with complex clinical presentations underscores the need for more intensive, personalized, and sustained interventions. Comparison between treatment recipients’ perceived helpfulness and objective clinical effectiveness is also needed.