JMIR Publications

ABSTRACT

Background:

Treatment-resistant depression (TRD), affecting approximately 20–30% of individuals with major depressive disorder, is associated with significant disability, reduced quality of life, and an increased risk of hospitalization and suicide. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation therapy, has demonstrated strong efficacy for TRD but is typically limited to research contexts or private clinics. Existing research on patient perspectives toward rTMS is limited and largely retrospective, focusing on individuals who have already undergone treatment. As a result, little is known about the factors that influence patients’ decisions to accept or decline rTMS at the time of referral, particularly within real-world clinical settings.

Objective:

This study will prospectively examining decision-making processes surrounding rTMS in a community hospital outpatient clinic.

Methods:

This prospective mixed-methods cohort study will recruit 30 adults with TRD referred to a public rTMS clinic. Participants will be stratified based on their decision to opt in or out of treatment. Data collection will include hybrid card-sorting interviews, self-report questionnaires (assessing depression, well-being, cognitive flexibility, decisional conflict, and health literacy), and medical chart reviews. Each participant will complete a baseline and six-month follow-up interview and survey. Qualitative data will be analyzed using constant comparative analysis, informed by bounded rationality and prospect theory. Quantitative data will be analyzed using bivariate statistics and hierarchical cluster analysis to identify patterns in decision-making factors.

Results:

Recruitment will commence upon opening of the rTMS clinic.

Conclusions:

This is the first study known to prospectively examine decision-making around rTMS in a real-world, publicly funded clinic, including both individuals who initiate and those who decline treatment. Findings may inform the development of patient education and engagement materials, and highlight gaps in patient-provider communication during the rTMS decision-making process.