Role of patient treatment beliefs and provider characteristics in establishing treatment alliance

Purpose. Positive treatment alliance is associated with improved treatment outcomes for individuals with depression. Little is known about how patient treatment beliefs influence treatment alliance. We evaluated the relationship between patient beliefs about treatment and treatment alliance, examining potential differences by gender, race, and current diagnosis of depression. Methods. We used an embedded concurrent mixed methods study design to collect cross-sectional descriptive data from 227 Black and White primary care patients presenting with depression symptoms in primary care settings in a large urban hospital network. Individuals were randomized into either the survey (198) or interview (29) arms. We used multiple/ordinary least squares regression to evaluate the association between patient beliefs and treatment alliance. To complement these findings we conducted thematic analyses of qualitative data which was managed using Atlas.ti. Results. Patients who believed their providers would respectfully facilitate depression treatment reported higher bond, confidence, and openness with their provider. Current depression diagnosis decreased, but did not eliminate the effect of patients' belief on their openness with their providers. This was echoed in the qualitative findings in which listening and perception that the physician cared about the patient were predominant themes. Conclusions. Creating primary care environments where individuals feel safe in sharing psychological distress is essential in early identification and treatment of depression. Increasing provider empathy and emotive expression increases patients' trust in primary care physicians as facilitators of depression treatment. Skills based training of physicians in attentiveness and active listening will influence effectiveness in depression intervention.