Methods: A survey was conducted with 30 general practitioners and 207 depressed patients, at initial consultation and six to eight weeks later. General practitioners documented their clinical practice and patients completed questionnaires including Brief-PHQ for depression and clinical outcome, patient participation (scale by Man-Son-Hing) and visual analogue scales for treatment adherence.

Results: Correlation analysis showed significant correlations between patient participation and adherence (patient rating r=.36, physician rating r=.21, p<.05) and between patient participation and clinical outcome was attributable to patient adherence (beta=.41) and baseline depression severity (beta=.65). Depression severity predicted clinical outcome but not patient participation. Participation predicted adherence but did not directly affect clinical outcome. Adherence was explainable by physician (beta = .57) and patient reported treatment adherence (beta =.66)

Conclusion: In a specific pathway via adherence improving patient participation in decision making can foster improved clinical outcomes. The research findings reveal the significance of patient participation as key factor to address for improving treatment adherence and clinical outcome. Quality improvement strategies for depression treatment should emphasize patient participation.