1
|
Tsoh JY, Takubo Y, Fukui E, Suzuki A, Iwai M, Saito H, Tsujino N, Uchino T, Katagiri N, Nemoto T. Exploring early discontinuation of mental health outpatient treatment: language, demographics and clinical characteristics among migrant populations in Japan. BMJ MENTAL HEALTH 2024; 27:e301059. [PMID: 38960880 PMCID: PMC11227775 DOI: 10.1136/bmjment-2024-301059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/30/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The fast-growing migrant population in Japan and globally poses challenges in mental healthcare, yet research addressing migrants' mental health treatment engagement remains limited. OBJECTIVE This study examined language proficiency, demographic and clinical characteristics as predictors of early treatment discontinuation among migrants. METHODS Electronic health record data from 196 adult migrants, identified from 14 511 patients who received mental health outpatient treatment during 2016 and 2019 at three central hospitals in the Tokyo-Yokohama metropolitan region of Japan, were used. We conducted multivariable regression models to identify predictors of early discontinuation within 3 months. FINDINGS The study cohort (65% women, age range: 18-90 years, from 29 countries or regions) included 23% non-Japanese speakers. Japanese and non-Japanese speakers had similar discontinuation rates (26% vs 22%). Multivariable models revealed younger age (OR=0.97; 95% CI: 0.95, 0.99; p=0.016) and those with a primary diagnosis other than a schizophrenia spectrum disorder (OR=3.99; 95% CI: 1.36, 11.77; p=0.012) or a neurotic, stress-related and somatoform disorder (OR=2.79; 95% CI: 1.14, 6.84; p=0.025) had higher odds of early discontinuation. These effects were more pronounced among the Japanese speakers with significant language-by-age and language-by-diagnoses interactions. CONCLUSION Younger age and having a primary diagnosis other than a schizophrenia spectrum disorder or a neurotic, stress-related and somatoform disorder increased vulnerability for discontinuing mental health treatment early in Japanese-speaking migrants but not for migrants with limited Japanese proficiency. CLINICAL IMPLICATIONS Understanding language needs within a context of mental health treatment should go beyond assumed or observed fluency. Unmet language needs might increase vulnerability for treatment disengagement among migrants. Targeted clinical efforts are crucial for enhancing early treatment engagement and informing health practices in Japan and countries with growing migrant populations.
Collapse
Affiliation(s)
- Janice Y Tsoh
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
- Department of Psychiatry and Implementation Science, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Youji Takubo
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
- Department of Psychiatry and Implementation Science, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Eriko Fukui
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
- Department of Psychiatry and Implementation Science, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Ayaka Suzuki
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Momoko Iwai
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Hisaaki Saito
- Department of Neuropsychiatry, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
| | - Naohisa Tsujino
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
- Department of Psychiatry, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Takashi Uchino
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
- Department of Psychiatry and Implementation Science, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Naoyuki Katagiri
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
- Department of Psychiatry and Implementation Science, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
- Department of Psychiatry and Implementation Science, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| |
Collapse
|
2
|
Aafjes-van Doorn K, Spina DS, Horne SJ, Békés V. The association between quality of therapeutic alliance and treatment outcomes in teletherapy: A systematic review and meta-analysis. Clin Psychol Rev 2024; 110:102430. [PMID: 38636207 DOI: 10.1016/j.cpr.2024.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/28/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The strength of the therapeutic alliance is widely understood to impact treatment outcomes, however, the alliance-outcome relationship in teletherapy has remained relatively unexamined. The aim of this meta-analysis is to systematically summarize the relationship between therapeutic alliance and treatment outcomes in teletherapy with adult patients conducted via videoconferencing or telephone. METHODS We conducted a systematic search of the databases PsycINFO, PsycARTICLES, ProQuest Dissertation Databases, EMBASE, The Cochrane Library, MEDLINE, Google Scholar, and PubMed for studies published before June 26, 2023. We identified 31 studies with 34 independent samples (4862 participants). RESULTS The average weighted effect size was 0.15, p = .001, 95% CI [0.07, 0.24], k = 34. reflecting a small effect of therapeutic alliance on mental health outcomes. There was significant heterogeneity in the effect sizes, which was driven by between-study differences in the alliance-outcome correlation. The alliance-outcome effect was larger when the alliance was measured late in treatment and when the outcome was measured from the patient's perspective. CONCLUSION Very few teletherapy treatment studies were identified that initially reported on alliance-outcome associations, underlining that this is an under-researched area. The association between alliance-teletherapy outcomes in this meta-analysis was small but significant, and somewhat weaker than the alliance-outcome associations reported for in-person treatments and other online interventions. This might indicate that there are other processes at play in teletherapy that explain variance of treatment outcomes, or that the therapist (and the relationship) has less influence on the treatment outcomes than in in-person therapy.
Collapse
Affiliation(s)
| | - Daniel S Spina
- Pennsylvania State University, Psychology Department, PA, USA
| | - Sarah J Horne
- Yeshiva University, Ferkauf Graduate School of Psychology, New York, USA
| | - Vera Békés
- Yeshiva University, Ferkauf Graduate School of Psychology, New York, USA
| |
Collapse
|
3
|
Lin CY, Shih FC, Ho YH. Applying the Balanced Scorecard to Build Service Performance Measurements of Medical Institutions: An AHP-DEMATEL Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1022. [PMID: 36673778 PMCID: PMC9859192 DOI: 10.3390/ijerph20021022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
The main purpose of this study is to explore the application of the balanced scorecard (BSC) to service performance measurements of medical institutions using the analytic hierarchy process (AHP) and decision making and trial evaluation laboratory (DEMATEL). According to the concept of BSC, a total of four evaluation dimensions and twenty-two indicators of medical service performance measurements were developed. To collect data, this study delivered expert questionnaires to medical-related professional supervisors, deans, and heads of medical institutions in Taiwan. By combining the AHP and DEMATEL, the priority and causality of service performance standards in medical institutions were obtained. The results of this study show that the customer dimension is the most important service performance measurement dimension for medical institutions. The seven key service performance measurement indicators that are most important for medical institutions, in order, are "complete and comfortable equipment", "competitiveness of the medical profession", "continuity of patient-to-hospital treatment", "classification of medical profession according to customers (VIP system)", "complete medical service", "complete salary, remuneration, and policy", and "medical incomes of institutions". In terms of causality, provided the complete services of medical institutions are improved, the continuity of patient-to-hospital treatment, the competitiveness of the medical profession, and the medical incomes of institutions would be influenced.
Collapse
Affiliation(s)
- Chieh-Yu Lin
- Department of International Business, Chang Jung Christian University, Tainan 71101, Taiwan
| | - Fu-Chiang Shih
- Ph.D. Program in Business and Operations Management, Chang Jung Christian University, Tainan 71101, Taiwan
| | - Yi-Hui Ho
- Department of International Business, Chang Jung Christian University, Tainan 71101, Taiwan
| |
Collapse
|
4
|
Immel N, Dagnino P, Hunger-Schoppe C. Associations between patient personality, symptomatic change and therapy dropout. Clin Psychol Psychother 2021; 29:922-932. [PMID: 34520091 DOI: 10.1002/cpp.2670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/08/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Studies show that 16% to 77% of psychotherapy patients abandon therapy within the first sessions. The aim of this study is to examine how patient personality variables, specifically the patients' structural integration and the personality traits dependency and self-criticism, are associated with symptomatic change and therapy dropout. METHOD We analysed data from 96 patients (age: M = 30.56, SD = 11.39; 78.5% women; 44.6% students, 28.3% employees). A hierarchical logistic regression analysis was carried out to determine whether patients' structural integration (assessed via the OPD-SQ) and their level of dependency and self-criticism (DEQ) can predict therapy dropout. In addition, a multiple regression was used to analyse how these variables affect symptomatic change (OQ-45.2 symptom subscale). RESULTS The interaction of structural integration level and dependency best predicts therapy dropout. For the prediction of symptomatic change, both structural integration and dependency were significant. However, their interaction showed no significant results. DISCUSSION The patient's structural integration was associated to both symptomatic change and dropout. Therapists' training should include techniques addressing patients' structural integration and degree of dependency to prevent patient dropout from therapy.
Collapse
Affiliation(s)
- Nina Immel
- Department of Psychology, Pontificia Universidad Catolica de Chile, Santiago, Chile.,Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Paula Dagnino
- Faculty of Psychology, Universidad San Sebastian, Santiago, Chile
| | | |
Collapse
|
5
|
Dietrichkeit M, Hagemann-Goebel M, Nestoriuc Y, Moritz S, Jelinek L. Side effects of the metacognitive training for depression compared to a cognitive remediation training in patients with depression. Sci Rep 2021; 11:7861. [PMID: 33846503 PMCID: PMC8041905 DOI: 10.1038/s41598-021-87198-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/10/2021] [Indexed: 12/27/2022] Open
Abstract
Although awareness of side effects over the course of psychotherapy is growing, side effects are still not always reported. The purpose of the present study was to examine side effects in a randomized controlled trial comparing Metacognitive Training for Depression (D-MCT) and a cognitive remediation training in patients with depression. 84 patients were randomized to receive either D-MCT or cognitive remediation training (MyBrainTraining) for 8 weeks. Side effects were assessed after the completion of each intervention (post) using the Short Inventory of the Assessment of Negative Effects (SIAN) and again 6 months later (follow-up) using the Negative Effects Questionnaire (NEQ). D-MCT and MyBrainTraining did not differ significantly in the number of side effects. At post assessment, 50% of the D-MCT group and 59% of the MyBrainTraining group reported at least one side effect in the SIAN. The most frequently reported side effect was disappointment in subjective benefit of study treatment. At follow-up, 52% reported at least one side effect related to MyBrainTraining, while 34% reported at least one side effect related to the D-MCT in the NEQ. The most frequently reported side effects fell into the categories of "symptoms" and "quality". Our NEQ version was missing one item due to a technical error. Also, allegiance effects should be considered. The sample size resulted in low statistical power. The relatively tolerable number of side effects suggests D-MCT and MyBrainTraining are safe and well-received treatment options for people with depression. Future studies should also measure negative effects to corroborate our results.
Collapse
Affiliation(s)
- Mona Dietrichkeit
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany.
| | | | - Yvonne Nestoriuc
- Institute of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Clinical Psychology, Helmut-Schmidt-University/University of the Federal Armed Forces Hamburg, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
6
|
Abstract
Psychotherapy dropout is often regarded as an indicator of treatment failure; however, evidence of a relationship between dropout and outcome has not been well established. The current research consisted of three meta-analytic studies, the results of which found (a) individuals who dropped out began treatment more distressed than those who completed therapy, (b) individuals who dropped out of therapy were more distressed at posttreatment than individuals who completed therapy, and (c) treatments with higher rates of dropout were also less effective for the treatment completers. Dropout may particularly signal poor outcomes for shorter treatments. The continued ambiguity in the meaning of dropout is discussed as well as the promising potential for future research in the area of dropout as it relates to outcome.
Collapse
Affiliation(s)
- Catherine M Reich
- Department of Psychology, University of Minnesota Duluth, Duluth, MN, USA
| | - Jeffrey S Berman
- Department of Psychology, University of Memphis, Memphis, TN, USA
| |
Collapse
|