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KEY FINDINGS
Among stakeholder groups, psychiatrists reported more favorable views of PEIs than did non-clinicians (the general public, caregivers, and patients). Throughout the survey, the three non-clinician groups had very similar attitudes and concerns.
Across treatment modalities, participants viewed rTMS more favorably than ECT and the two implantable PEIs (DBS and ABIs) as least favorable overall.
By Stakeholder Group
Compared to psychiatrists, non-clinicians perceived their assigned PEI as more invasive.
SCALE
1 not at all
2 minimally
3 somewhat
4 moderately
5 substantially
6 greatly
Compared to psychiatrists, non-clinicians perceived their assigned PEI as riskier but also just as beneficial.
SCALE
1 not at all
2 minimal
3 slight
4 moderate
5 substantial
6 great
By Treatment Modality
Participants reported more positive affect toward ECT and rTMS relative to the implantables PEIs.
SCALE
1 most negative
2 more negative
3 slightly negative
4 neutral
5 slightly positive
6 more positive
7 most positive
By Stakeholder Group AND Treatment Modality
The most frequently mentioned barrier to the use of PEIs by each stakeholder group was “limited evidence of the treatment’s effectiveness.” The percentages of non-clinicians perceiving this as the most important barrier were similar across treatment modality, while the same percentages of psychiatrists varied greatly by treatment.
Each non-clinician stakeholder group most frequently mentioned “limited evidence of the treatment’s safety” as their top ethical concern about the use of PEIs. The percentages of non-clinicians identifying this as their top ethical concern were similar across treatment modality. Psychiatrists most frequently mentioned “patient not getting the treatment when it would actually help them” as their top ethical concern about the use of PEIs. The percentages of psychiatrists identifying this as their top ethical concern varied greatly across treatment
modality.
Psychiatrists
Psychiatrists recruited for this study are board-certified clinicians, most of whom have had at least some experience with and/or interest in neuromodulation techniques.
Patients
Patients recruited for this study are adults in the general public who reported a prior diagnosis of clinical depression (MDD). They were not required to have experience with PEIs to participate.
Caregivers
Caregivers recruited for this study are adults in the general public with at least moderate experience caregiving for a family member or a close friend with clinical depression.
Public
Members of the general public recruited for this study are adults in the general population with no diagnosed psychiatric disorder or caregiving experience.
Experience with Caregiving
Refers to adults’ prior engagement helping and supporting a family member or close friend diagnosed with depression. We defined “care” as helping them with daily activities, driving them to appointments, offering emotional or financial support, preparing meals, etc.
Experience with PEI
Refers to participants’ prior engagement with PEIs. We measured non-clinicians’ level of awareness of PEIs. In addition, we asked patients if they had previously used PEIs. We asked psychiatrists about the extent to which they have referred patients for PEIs or directly administered the PEIs to patients.
Affect
Refers to participants’ immediate emotional response to their presented PEI, which we measured along a continuum of negative to positive attributes.
Perceived Barriers
Refers to participants’ assessment of the potential obstacles that may partially impede or completely prevent the use of their presented PEI. We consider two types of barriers.
Structural barriers are bureaucratic, economic, or infrastructural factors associated with health services, including availability of services, administrative challenges, limited resources, cost of equipment, and referral patterns by psychiatrists and other clinicians.
Attitudinal barriers are beliefs, attitudes, or emotions that inhibit seeking help and treatment—such as stigma, fear of treatment, negative health beliefs (e.g., concerns about memory loss), misinterpretations or uncertainty about treatment consequences, and perceived ethical issues.
Perceived Benefits
Refers to participants’ assessment of the likely positive impacts of using their presented PEI or the likely comparative advantage of using their presented PEI relative to another option (e.g., quicker results, safer, more easily adjustable).
Perceived Effects on Self
Refers to participants’ assessment of how much their presented PEI negatively or positively influences key aspects of their sense of self (e.g., their personality, independence, self-control, and free will).
Perceived Ethical Concerns
Refers to participants’ assessment of how fundamental principles of rights, fairness, and justice are upheld with the use of their presented PEI. Such concerns include the safety and effectiveness of treatments, the sufficiency of informed consent, and the invasiveness of the treatment.
Perceived Invasiveness
Refers to participants’ assessment of how much their presented PEI intrudes upon them physically, cognitively, psychologically, and socially and otherwise interferes with their daily life.
Perceived Risks
Refers to participants’ assessment of the likely negative consequences of using their assigned PEI (e.g., injury, dependence, psychological harm, and social stigma).
WHAT ARE SOME OTHER TREATMENTS FOR DEPRESSION?
Antidepressants
A class of medication that have been approved by the US Food and Drug Administration (FDA) for the treatment of depression. It usually takes 4-6 weeks for this medication to take effect, but some patients start to feel relief from symptoms in as little as one week. Antidepressants work by altering the levels of brain chemicals, or by making the chemicals more easily available for the brain to use.
Psychotherapy
Also known as talk therapy, is a series of directed conversations between patients and therapists to help control symptoms of depression and other psychiatric conditions. A psychotherapy session can be between 30-50 minutes long, and the number of sessions needed per week vary depending on the therapist and the condition being treated. There are several different types of psychotherapy. To get the most out of therapy, the patient must be cooperative, open, and honest with their therapist. Patients may need to try out psychotherapy with several different therapists before finding one they trust, and one they feel suits their needs. Psychotherapy can be, and often is, combined with other treatments for depression. While psychotherapy does not physically affect a patient, it can have emotional side effects.
Vagal Nerve Stimulation (VNS)
An approved US Food and Drug Administration (FDA) treatment for major depressive disorder that has not responded well to other types of therapies (aka, “treatment-resistant” depression). VNS involves the surgical implantation of a device by a neurosurgeon. The procedure takes about 45-90 minutes and is usually performed under anesthesia. This surgery does not involve the brain. Rather, the neurosurgeon makes two small incisions: one on the upper left side of the chest (where a battery-powered stimulator is implanted) and one on the left side of the lower neck (where thin, flexible wires are inserted to connect the stimulator to the vagus nerve). The neurospecialist programs the simulator to deliver an electrical pulse at a certain strength and duration. Patients are then given a handheld magnet that allows them to control the stimulator at home.