3
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van Dijk DA, Deen ML, van den Boogaard TM, Ruhé HG, Spijker J, Peeters FPML. Prevalence and prediction of dropout during depression treatment in routine outpatient care: an observational study. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01499-1. [PMID: 36253582 PMCID: PMC10359217 DOI: 10.1007/s00406-022-01499-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022]
Abstract
Efficacious treatments are available for major depressive disorder (MDD), but treatment dropout is common and decreases their effectiveness. However, knowledge about prevalence of treatment dropout and its risk factors in routine care is limited. The objective of this study was to determine the prevalence of and risk factors for dropout in a large outpatient sample. In this retrospective cohort analysis, routinely collected data from 2235 outpatients with MDD who had a diagnostic work-up between 2014 and 2016 were examined. Dropout was defined as treatment termination without achieving remission before the fourth session within six months after its start. Total and item scores on the Dutch Measure for Quantification of Treatment Resistance in Depression (DM-TRD) at baseline, and demographic variables were analyzed for their association with dropout using logistic regression and elastic net analyses. Data of 987 subjects who started routine outpatient depression treatment were included in the analyses of which 143 (14.5%) dropped out. Higher DM-TRD-scores were predictive for lower dropout odds [OR = 0.78, 95% CI = (0.70-0.86), p < 0.001]. The elastic net analysis revealed several clinical variables predictive for dropout. Higher SES, higher depression severity, comorbid personality pathology and a comorbid anxiety disorder were significantly associated with less dropout in the sample. In this observational study, treatment dropout was relatively low. The DM-TRD, an easy-to-use clinical instrument, revealed several variables associated with less dropout. When applied in daily practice and combined with demographical information, this instrument may help to reduce dropout and increase treatment effectiveness.
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Affiliation(s)
- D A van Dijk
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands. .,Department of Mood Disorders, PsyQ Haaglanden, The Hague, The Netherlands. .,Parnassia Psychiatric Institute, Monsterseweg 93, 2553 RJ, The Hague, The Netherlands.
| | - M L Deen
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Institute of Psychology, Leiden University, Leiden, The Netherlands
| | | | - H G Ruhé
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.,Donders Institute for Brain and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - J Spijker
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Pro Persona Mental Healthcare, Nijmegen, The Netherlands
| | - F P M L Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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4
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Premature dropout from psychotherapy: Prevalence, perceived reasons and consequences as rated by clinicians. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e6695. [DOI: 10.32872/cpe.6695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background
Why clients discontinue their psychotherapies has attracted more attention recently as it is a major problem for many healthcare services. Studies suggest that dropout rates may be affected by the mode of therapy, low-quality therapeutic alliance, low SES, and by conditions such personality disorders or substance abuse. The aims of the study were to investigate what happens in therapies which end in a dropout, and to estimate how common dropout is as reported by practicing clinicians.
Method
An online questionnaire was developed and completed by 116 therapists working in clinical settings. They were recruited via social media (Facebook and different online psychotherapy groups) in Sweden and worked with Cognitive Behavioural Therapy (CBT), Psychodynamic Therapy (PDT), Interpersonal Psychotherapy (IPT) and Integrative Psychotherapy (IP).
Results
Psychotherapists rated the frequency of premature dropout in psychotherapy to be on average 8.89% (MD = 5, SD = 8.34, Range = 0-50%). The most common reasons for a dropout, as stated by the therapists, were that clients were not satisfied with the type of intervention offered, or that clients did not benefit from the treatment as they had expected. The most common feeling following a dropout was self-doubt.
Conclusion
In conclusion, premature dropout is common in clinical practice and has negative emotional consequences for therapists. Premature dropout may lead to feelings of self-doubt and powerlessness among therapists. The therapeutic alliance was mostly rated as good in dropout therapies. Further research is needed to validate the findings with data on the prevalence and subjective reasons behind a dropout from point of view of clients.
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Urmanche AA, Lipner LM, Bloch-Elkouby S, Hunter E, Kaufmann J, Warren JT, Weil GT, Eubanks CF, Muran JC. The beginning of the end: A comparison of treatment completers and early dropouts in trainee-provided time-limited Cognitive Behavioral Therapy. COUNSELLING PSYCHOLOGY QUARTERLY 2022; 35:763-788. [PMID: 36684503 PMCID: PMC9856216 DOI: 10.1080/09515070.2021.1997916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
About one in five clients drops out of treatment prematurely. Premature termination has been found to correlate with patient, therapist, and treatment factors, as well as complex interpersonal processes, including ruptures in the therapeutic alliance. This study examines the therapeutic alliance using a qualitative approach to patient-, therapist-, and observer-based data. The sample includes five trainee therapists, each of whom worked with one patient who terminated after the first or second session, and one who completed a cognitive-behavioral therapy protocol. The session(s) preceding premature termination in the drop case and the corresponding session(s) in the completer case were examined. Rupture resolution process was prevalent in both groups, though confrontation ruptures seemed more prevalent with completers and withdrawal ruptures were more clinically impactful with dropouts. Therapist awareness of process and responsiveness or contribution to rupture were identified as potential factors contributing to patient retention.
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Affiliation(s)
- Adelya A. Urmanche
- Derner School of Psychology, Adelphi University, Hy Weinberg Center, 158 Cambridge Avenue, Garden City, NY 11530, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Lauren M. Lipner
- Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Sarah Bloch-Elkouby
- Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Elaine Hunter
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY 10461, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Jerzy Kaufmann
- The New School for Social Research, 80 Fifth Avenue, New York, NY 10011,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Jonathan T. Warren
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY 10461, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Gregory T. Weil
- The New School for Social Research, 80 Fifth Avenue, New York, NY 10011,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Catherine F. Eubanks
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY 10461, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - J. Christopher Muran
- Derner School of Psychology, Adelphi University, Hy Weinberg Center, 158 Cambridge Avenue, Garden City, NY 11530, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
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8
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Swift JK, Spencer J, Goode J. Improving psychotherapy effectiveness by addressing the problem of premature termination: Introduction to a special section. Psychother Res 2018; 28:669-671. [DOI: 10.1080/10503307.2018.1439192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Joshua K. Swift
- Department of Psychology, Idaho State University, Pocatello, ID, USA
| | - Julie Spencer
- Department of Psychology, Idaho State University, Pocatello, ID, USA
| | - Jonathan Goode
- Department of Psychology, Idaho State University, Pocatello, ID, USA
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