Psychological Medicine

Original Articles

Anticipated Benefits of Care (ABC): psychometrics and predictive value in psychiatric disorders

D. Wardena1 c1, M. H. Trivedia1, T. J. Carmodya1, J. K. Gollana2, T. M. Kashnera1, L. Linda3, M. L. Crismona4 and A. J. Rusha5

a1 Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA

a2 Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA

a3 Department of Veterans Affairs, North Texas Health Care System, Dallas, TX, USA

a4 University of Texas College of Pharmacy, Austin, TX, USA

a5 Duke-National University of Singapore, Singapore


Background Attitudes and expectations about treatment have been associated with symptomatic outcomes, adherence and utilization in patients with psychiatric disorders. No measure of patients' anticipated benefits of treatment on domains of everyday functioning has previously been available.

Method The Anticipated Benefits of Care (ABC) is a new, 10-item questionnaire used to measure patient expectations about the impact of treatment on domains of everyday functioning. The ABC was collected at baseline in adult out-patients with major depressive disorder (MDD) (n=528), bipolar disorder (n=395) and schizophrenia (n=447) in the Texas Medication Algorithm Project (TMAP). Psychometric properties of the ABC were assessed, and the association of ABC scores with treatment response at 3 months was evaluated.

Results Evaluation of the ABC's internal consistency yielded Cronbach's α of 0.90–0.92 for patients across disorders. Factor analysis showed that the ABC was unidimensional for all patients and for patients with each disorder. For patients with MDD, lower anticipated benefits of treatment was associated with less symptom improvement and lower odds of treatment response [odds ratio (OR) 0.72, 95% confidence interval (CI) 0.57–0.87, p=0.0011]. There was no association between ABC and symptom improvement or treatment response for patients with bipolar disorder or schizophrenia, possibly because these patients had modest benefits with treatment.

Conclusions The ABC is the first self-report that measures patient expectations about the benefits of treatment on everyday functioning, filling an important gap in available assessments of attitudes and expectations about treatment. The ABC is simple, easy to use, and has acceptable psychometric properties for use in research or clinical settings.

(Received April 29 2009)

(Revised August 11 2009)

(Accepted August 15 2009)

(Online publication September 29 2009)


c1 Address for correspondence: D. Warden, Ph.D., M.B.A., Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9119, USA. (Email: