A multi-methods exploration of shared decision-making, lived experience, and opioid use disorder among emerging adults with anxiety and depression

  • Author / Creator
    Marshall, Richard Tyler
  • Background
    Anxiety/depression are common in emerging adults and may lead to poor coping strategies such as substance use. Shared decision-making (SDM) occurs when clinicians and patients make health decisions together informed by the best available evidence inclusive of the patient’s values/preferences. Among adults with chronic diseases (e.g., diabetes), evidence suggests SDM may enhance patient outcomes such as satisfaction with care, health-related quality of life (HRQL) and patient health engagement (PHE). Whether SDM benefits emerging adults with anxiety and/or depression remains to be elucidated.
    i. To explore whether SDM is associated with patient outcomes such as anxiety/depression, PHE, and HRQL.
    ii. To describe the narrative account of emerging adults coping with anxiety/depression.
    iii. To investigate whether previous anxiety and/or depressive disorders are associated with subsequent opioid use disorders (OUD).
    Chapter 2: A systematic literature review was conducted exploring whether SDM is associated with clinically relevant outcomes compared to usual care in adults 18-64 years with anxiety/depression. Study eligibility criteria: i) prospectively controlled trials, ii) peer-reviewed and published in English-language.

    Chapter 3: A narrative inquiry was conducted exploring the experiences and decision-making preferences of emerging adults coping with anxiety/depression. Data were obtained by conducting unstructured verbal interviews in mental health and primary care settings. The data were transcribed verbatim and analyzed descriptively.
    Chapter 4: A cross-sectional study was conducted exploring whether SDM was associated with changes in PHE, HRQL, anxiety/depression in emerging adults (18-29 years) with anxiety/depression. Data were analyzed using non-parametric statistical methods.
    Chapter 5: An age/sex matched case-control study was conducted exploring whether previously diagnosed anxiety and/or depressive disorders were associated with subsequent OUD in emerging adults (18-25 years). Administrative health data were analyzed, and adjusted odds ratios were calculated using conditional logistic regression.
    Chapter 2: Six randomized controlled trials (N=1,834 participants, 18-64 years) were included. SDM improved the following outcomes: patient satisfaction (n=3 studies), adequate treatment for depression (n=3 studies), decrease in anxiety symptom severity (n=1 studies), patient involvement in decision-making (n=3 studies). No studies or data of emerging adults were obtained. Quality of the evidence ranged from low to moderate.
    Chapter 3: Twelve emerging adults with anxiety and/or depression were interviewed. Common narratives included: i) feeling overwhelmed, ii) social/peer pressure, iii) withdrawing socially, iv) self-medicating with substances/alcohol, v) seeking mental health care as a last resort, vi) positive social support may facilitate seeking treatment, vi) increased involvement in decision-making may impact satisfaction with care and treatment adherence.
    Chapter 4: Thirty-one healthcare providers and 42 emerging adult patients (22% male) were recruited from six primary care and eight mental health settings in Alberta. Excellent use of SDM during an initial consultation was not associated with PHE, anxiety/depression or HRQL compared to acceptable/unacceptable SDM. P
    Chapter 5: We identified N=1,848 cases and N=7,392 controls. Later OUD was associated with the following preexisting disorders: anxiety, aOR=2.53 (95% CI=2.16 – 2.96); depression, aOR=2.20 (95% CI=1.80 – 2.70); and concurrent anxiety and depression, aOR 1.94 (95% CI=1.56 – 2.40). Post-hoc analyses revealed subsequent OUD diagnoses were associated with the following preexisting concurrent disorders: anxiety and alcohol, aOR=1.94 (95% CI=1.56 – 2.40); depression and alcohol, aOR=6.47 (95% CI=4.73 = 8.84); anxiety, depression and alcohol, aOR=6.09 (95% CI=4.41 – 8.42).
    It is unknown whether the use of SDM during clinic visits may enhance patient outcomes in emerging adults with anxiety and/or depression. The literature obtained from the systematic review suggests SDM may either improve or provide no benefit on patient-reported outcomes in adults with depressive disorders. Our cross-sectional study found no relationship between SDM and HRQL, PHE, and anxiety/depression in emerging adults. The obtained qualitative evidence suggests i) emerging adults may have diverse experiences, expectations, and values for managing symptoms of anxiety/depression, ii) inclusive approaches to care such as SDM may be valued. Previous anxiety/depression in youth is associated with developing subsequent OUD. Alcohol-related disorders in addition to anxiety/depression considerably amplify the risk of OUD. More longitudinal research is needed to determine whether SDM provides benefit for emerging adults with mental health concerns. More research is urgent needed to reduce the burden of anxiety/depression and substance use in youth. More research around person-centred care and SDM are warranted in people with anxiety disorders and emerging adults.

  • Subjects / Keywords
  • Graduation date
    Fall 2021
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.