Patient Preference for Psychological vs Pharmacologic Treatment of Psychiatric Disorders: A Meta-Analytic Review
Open accessAbstract
OBJECTIVE: Evidence-based practice involves the consideration of efficacy and effectiveness, clinical expertise, and patient preference in treatment selection. However, patient preference for psychiatric treatment has been understudied. The aim of this meta-analytic review was to provide an estimate of the proportion of patients preferring psychological treatment relative to medication for psychiatric disorders. DATA SOURCES: A literature search was conducted using PubMed, PsycINFO, and the Cochrane Collaboration library through August 2011 for studies written in English that assessed adult patient preferences for the treatment of psychiatric disorders. The following search terms and subject headings were used in combination: patient preference, consumer preference, therapeutics, psychotherapy, drug therapy, mental disorders, depression, anxiety, insomnia, bipolar disorder, schizophrenia, substance-related disorder, eating disorder, and personality disorder. In addition, the reference sections of identified articles were examined to locate any additional articles not captured by this search. STUDY SELECTION: Studies that assessed preferred type of treatment and included at least 1 psychological treatment and 1 pharmacologic treatment were included. Of the 644 articles identified, 34 met criteria for inclusion. DATA EXTRACTION: Authors extracted relevant data including the proportion of participants reporting preference for psychological or pharmacologic treatment. RESULTS: The proportion of adult patients preferring psychological treatment was 0.75 (95% CI, 0.69-0.80), which was significantly higher than equivalent preference (ie, higher than 0.50; P < .001). Sensitivity analyses suggested that younger patients (P = .05) and women (P < .01) were significantly more likely to choose psychological treatment. A preference for psychological treatment was consistently evident in both treatment-seeking and unselected (ie, non-treatment-seeking) samples (P < .001 for both) but was somewhat stronger for unselected samples. CONCLUSIONS: Aggregation of patient preferences across diverse settings yielded a significant 3-fold preference for psychological treatment. Given evidence for enhanced outcomes among those receiving their preferred psychiatric treatment and the trends for decreasing utilization of psychotherapy, strategies to maximize the linkage of patients to preferred care are needed.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 9 cited sources checked · 0 supported · 0 flagged
- Finding
Preference for psychological treatment was consistently present in both treatment-seeking and unselected samples, though it was somewhat stronger in unselected samples.
“A preference for psychological treatment was consistently evident in both treatment-seeking and unselected samples (ps < .05), but was somewhat stronger for the unselected samples.”
Quote in the paperNot yet classified - Finding
The combined population mean proportion preferring therapy was 0.75.
“The population mean proportion preferring therapy was 0.75 (95% CI: 0.69 to 0.80), which is significantly higher than 0.50 (p < 0.001), the proportion that would indicate equal preference for psychological and pharmacological treatment.”
Quote in the paperNot yet classified - Finding
The paper states that adults prefer psychological to pharmacological treatment for unipolar depression and anxiety disorders.
“This meta-analysis provides evidence that adults prefer psychological to pharmacological treatment for unipolar depression and anxiety disorders.”
Quote in the paperNot yet classified - Finding
Depression was the most commonly studied disorder, followed by posttraumatic stress disorder, other or unspecified disorders, and other anxiety disorders.
“the most commonly examined disorder was depression (65% of studies), followed by posttraumatic stress disorder (17%), other or unspecified disorders (12%), and other anxiety disorders (6%).”
Quote in the paperNot yet classified - Finding
The authors conclude that combining preferences across settings shows a three-fold preference for psychological treatment over medication.
“Aggregation of patient preferences across diverse settings yielded a significant three-fold preference for psychological treatment relative to medication.”
Quote in the paperNot yet classified
- Finding
Across studies, 75% of participants preferred psychological treatment, and this was significantly greater than chance-level equivalence with medication.
“Across studies, the proportion preferring psychological treatment was 0.75 (95% CI: 0.69 to 0.80), which was significantly higher than equivalent preference (i.e., higher than 0.50, p < .001).”
Quote in the paperNot yet classified - Finding
The meta-analysis included 34 studies.
“Of the 641 articles initially identified, 34 met criteria for inclusion.”
Quote in the paperNot yet classified - Finding
Younger patients and women were more likely to choose psychological treatment.
“Sensitivity analyses suggested that younger patients (p < .05) and women (p < .01) were significantly more like to choose psychological treatment.”
Quote in the paperNot yet classified - Finding
The authors report that the availability of alternative preference options was not associated with differences in the proportion preferring therapy.
“The availability of alternative preference options (e.g., combination therapy, watchful waiting/no treatment) was not associated with differences in the proportion preferring therapy (p = 0.92).”
Quote in the paperNot yet classified - Finding
The review included 34 studies with a total of 68,612 participants.
“The 34 studies included a total of 68,612 participants.”
Quote in the paperNot yet classified - Finding
The authors found that mean age was significantly associated with preference, with younger samples more likely to prefer psychological treatment.
“Mean age was significantly associated with the proportion preferring psychological treatment (p = 0.05), with younger samples being more likely to prefer psychological treatment than older samples.”
Quote in the paperNot yet classified - Finding
The authors found that sex was significantly associated with preference, with samples containing more women preferring therapy at higher rates.
“Sex was also significantly associated with the proportion preferring psychological treatment (p = 0.01), with samples with a greater proportion of women preferring therapy at higher rates.”
Quote in the paperNot yet classified - Finding
The authors conclude that the overall preference for psychological treatment over medication is robust to publication bias.
“We therefore conclude that the overall preference for psychological treatment over medication is robust to publication bias.”
Quote in the paperNot yet classified - Method
The study used a random-effects meta-analytic model after finding significant heterogeneity among studies.
“The Q test was highly significant (Q = 1,674, df = 33, p < 0.001), indicating that the studies are not homogenous. Therefore, the random effects model was adopted over the fixed effect model.”
Quote in the paperNot yet classified - Method
Studies were included only if they assessed preferred treatment type and included at least one psychological treatment and one pharmacological treatment.
“Studies assessing the preferred type of treatment including at least one psychological treatment and one pharmacological treatment were included.”
Quote in the paperNot yet classified - Method
The review aimed to estimate the proportion of patients who prefer psychological treatment over medication for psychiatric disorders.
“The aim of this meta-analytic review was to provide an estimate of the proportion of patients preferring psychological treatment relative to medication for psychiatric disorders.”
Quote in the paperNot yet classified - Method
The literature search used PubMed, PsycINFO, and the Cochrane Collaboration Library through August 2011 to find English-language studies of patient preferences for psychiatric treatment.
“A literature search was conducted using PubMed, PsycINFO, and the Cochrane Collaboration Library through August, 2011 for studies written in English that assessed patient preferences for the treatment of psychiatric disorders.”
Quote in the paperNot yet classified - Background
The authors note that limited access to evidence-based psychological treatments likely contributes to the shift toward medication and away from psychotherapy.
“limited access to evidence-based psychological treatments certainly plays some role.”
Quote in the paperNot yet classified0 of 2 sources checked- cites [28]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [29]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Background
The authors argue that, given comparable outcomes for depression and anxiety treatments, preference data support choosing psychological treatment more often.
“According to meta-analytic review, pharmacological and psychological treatments studied in clinical trials for treatment of depression and anxiety achieve comparable outcomes.”
Quote in the paperNot yet classified0 of 6 sources checked- cites [6]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [15]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [16]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [17]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [18]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [19]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Method
More than one psychological treatment or medication was collapsed into broader psychological or pharmacological categories.
“For studies in which more than one psychological treatment (e.g., group or individual) and/or more than one medication were presented, these options were collapsed under the broader headings of psychological or pharmacological treatment.”
Quote in the paperNot yet classified - Method
The study design required a forced-choice preference assessment for psychiatric treatment.
“criteria for inclusion in the analysis were: (a) use of a forced-choice assessment of participant preference for type of treatment for a psychiatric disorder;”
Quote in the paperNot yet classified0 of 1 sources checked- cites [12]
Not checked in the free run.
- Method
Only participants who expressed preference for psychological or pharmacological treatment were included when studies allowed additional choices.
“For these studies, only participants expressing preference for psychological or pharmacological treatment were included.”
Quote in the paperNot yet classified
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Evidence indicates that psychotherapeutic interventions are a preferred treatment option over pharmacotherapy amongst persons with lived depression experience.
“For example, evidence indicates that these interventions are a preferred treatment option over pharmacotherapy amongst persons with lived depression experience 73,260,261 .”
From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [260]
The Discussion reports that adults preferred psychological treatment to medication for depression and anxiety, and the Results > Subgroup Analysis finds the preference in both depression-focused and treatment-seeking studies. But the Introduction says the analysis also included unselected participants answering hypothetical treatment questions; the passages do not establish the finding specifically among people with lived experience of depression. Page numbers are unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPeople with mental health problems prefer psychological over pharmacological treatments.
“Although there is evidence to suggest that people with mental health problems prefer psychological over pharmacological treatments [6]”
From Translated and culturally adapted internet-delivered cognitive therapy for social anxiety disorder in Japanese clinical settings: study protocol for a randomised controlled trial (2024) · cites this paper as [6]
The Discussion reports that adults with unipolar depression or anxiety disorders preferred psychological to pharmacological treatment. The citing sentence broadens that finding to people with mental health problems generally, which the paper does not establish. (LLM, conf=0.82)
Experimental — accuracy not yet measuredMost patients (75% on average) prefer psychological treatment over pharmacological treatment for psychiatric disorders.
“despite most patients (75% on average) preferring the latter (McHugh et al., 2013).”
From Barriers to and Facilitators of Using Evidence-Based, Cognitive–Behavioral Anxiety Interventions in Integrated Primary Care Practice (2023) · cites this paper as McHugh et al., 2013
The Abstract Results report that 75% of participants across studies preferred psychological treatment. The Discussion limits its summary of that figure to depressive and anxiety disorders, so the claim's broader phrasing, 'psychiatric disorders,' is not fully supported. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMost patients prefer behavioral treatment.
“Anxiety is undertreated in primary care, and treatment provided is most often pharmacological (Stein et al., 2011; Weisberg et al., 2014) despite most patients preferring behavioral treatment (McHugh et al., 2013).”
From Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential (2024) · cites this paper as McHugh et al., 2013
More women than men prefer psychological treatment over medication treatment.
“More women than men prefer psychological treatment over medication treatment.36”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [36]
Common therapeutic options for SSRIs include fluoxetine, sertraline, citalopram, and fluvoxamine.
“Common therapeutic options include fluoxetine, sertraline, citalopram, and fluvoxamine (99–102)”
From The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease (2023) · cites this paper as [100]
The Methods (Data Synthesis) and Discussion address preferences for pharmacological versus psychological treatment, but do not identify specific drugs. Searches for the four named drugs and for SSRIs found no passage establishing that fluoxetine, sertraline, citalopram, and fluvoxamine are common therapeutic options. (LLM, conf=0.76)
Experimental — accuracy not yet measuredFor many common mental health conditions, particularly anxiety disorders, evidence-based psychological treatments are both the best treatment option and the preference of patients.
“for many common mental health conditions, particularly anxiety disorders, evidence-based psychological treatments are both the best treatment option2 and the preference of patients.3”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Conflicting counts of initially identified studies
MinorThe abstract says 641 articles were initially identified, while the Trial Flow section says 644 studies were initially identified and screened.
“Of the 641 articles initially identified, 34 met criteria for inclusion.”
“Based on the search methods used, 644 studies were initially identified and screened for inclusion/exclusion criteria.”
The citation lists haven’t been fetched yet
References 67 · Cited by 800
- Authors
- McHugh, R. K., Whitton, S. W., Peckham, A. D., Welge, J. A., & Otto, M. W.
- Affiliations
- McLean Hospital (US)
- University of Cincinnati (US)
- Massachusetts General Hospital (US)
- Boston University (US)
- Corresponding author
- McHugh, R. Kathryn
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2013-06-15
- Volume
- 74
- Issue
- 06
- Pages
- 595-602
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC4156137
- OpenAlex
- W1978560738
- Semantic Scholar
- 8052810e70da0086fd9f5f9b5fdc816139014498
- Cited by
- 800
- References
- 67
- Citations by year
- 2026: 37 · 2025: 69 · 2024: 85 · 2023: 68 · 2022: 75 · 2021: 71 · 2020: 108 · 2019: 66 · 2018: 51 · 2017: 57 · 2016: 42 · 2015: 39 · 2014: 25 · 2013: 4 · 2012: 1
- FWCI
- 54.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5ul1rr026314-03)
- National Institute of Mental Health (R25MH084784, R25 MH08478)
- National Center for Research Resources (UL1-RR026314, 5UL1RR026314-02)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- patient preferences, psychological intervention, psychotherapy, pharmacotherapy, mental illness, treatment selection, depression, anxiety, schizophrenia, bipolar disorder, substance-related disorders, eating disorders, personality disorders, insomnia, gender differences, age differences, treatment seeking, unselected patients, psychotherapy utilization
- MeSH terms
- Age Factors, Mental Disorders, Clinical Trials as Topic, Female, Humans, Male, Psychotherapy, Psychotropic Drugs, Sex Characteristics, Publication Bias, Patient Preference
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read (extract-v1) on 2026-09-24.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
