Second opinions for patients with a persistent depressive disorder: effects on severity of depression and quality of life

Background: A persistent depressive disorder has a major impact on patients and healthcare. Despite the advice in guidelines to seek a second opinion if there is insufficient evidence of recovery after treatment, and the great number of second opinions in psychiatric care for patients with a persistent depression, only a few studies have been published about their effects.

Methods: Multilevel analyses were conducted to compare mean test scores of an intervention group of patients with a persistent depressive disorder who received a second opinion with a matched control group, at three time points (baseline, intervention, follow-up).

Results: A significant decrease in severity of depression three months after the second opinion was found. There were no effects on quality of life and treatment satisfaction.

Limitations: The study sample was a convenience sample without randomisation. There were many missing values in the data and the follow-up after three months might be too short to expect effects of the recommendations from the second opinion. For treatment satisfaction there was ambiguity in the instruction.

Conclusions: A second opinion can be of value for persistent depression. Further research should answer the question whether the effect found is caused by the second opinion itself or by results from subsequent changes in treatment.