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Bautista CL, Bourassa KA, Vasquez NN, Desrochers M, Bartek N, Madan A. Nursing Staff in a Large Hospital System Underutilize Insurance-Based Mental Health Services. Healthcare (Basel) 2024; 12:1188. [PMID: 38921306 PMCID: PMC11203893 DOI: 10.3390/healthcare12121188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
Nurses are at high risk of burnout and subsequent mental health concerns due to problems with overstaffing, immense workload volume, and personal health risks associated with the job. Effective mental health treatments are available but potential barriers to receiving care may prevent nurses from benefiting. The Emotional Health and Well-Being Clinic (EHWC) at Houston Methodist is an outpatient mental health clinic offering therapy and medication management services for employees and employee dependents of our institution. The EHWC is uniquely positioned to observe how nurses utilize mental health services and to address barriers to effective care for this vital group of healthcare professionals. This paper provides descriptive data on the utilization of mental health services by nurses in the EHWC and a discussion of possible challenges faced by this group when seeking care. Based on these data, we propose potential solutions to ensure that nurses can achieve maximum benefit from outpatient mental health services.
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Affiliation(s)
- Chandra L. Bautista
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX 77030, USA; (C.L.B.); (N.N.V.); (M.D.); (N.B.); (A.M.)
- Houston Methodist Academic Institute, Houston, TX 77030, USA
| | - Katelynn A. Bourassa
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX 77030, USA; (C.L.B.); (N.N.V.); (M.D.); (N.B.); (A.M.)
- Houston Methodist Academic Institute, Houston, TX 77030, USA
| | - Namrata N. Vasquez
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX 77030, USA; (C.L.B.); (N.N.V.); (M.D.); (N.B.); (A.M.)
| | - Madeleine Desrochers
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX 77030, USA; (C.L.B.); (N.N.V.); (M.D.); (N.B.); (A.M.)
| | - Nicole Bartek
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX 77030, USA; (C.L.B.); (N.N.V.); (M.D.); (N.B.); (A.M.)
| | - Alok Madan
- Department of Psychiatry & Behavioral Health, Houston Methodist, Houston, TX 77030, USA; (C.L.B.); (N.N.V.); (M.D.); (N.B.); (A.M.)
- Houston Methodist Academic Institute, Houston, TX 77030, USA
- Houston Methodist Research Institute, Houston, TX 77030, USA
- Department of Psychiatry, Weill Cornell Medical College, New York, NY 10065, USA
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2
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Hanevik E, Røvik FMG, Bøe T, Knapstad M, Smith ORF. Client predictors of therapy dropout in a primary care setting: a prospective cohort study. BMC Psychiatry 2023; 23:358. [PMID: 37226210 DOI: 10.1186/s12888-023-04878-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Therapy dropout poses a major challenge. Considerable research has been conducted on predictors of dropout, however none in the context of primary mental health services in Norway. The purpose of this study was to investigate which client characteristics can predict dropout from the service Prompt Mental Health Care (PMHC). METHODS We performed a secondary analysis of a Randomized Controlled Trial (RCT). Our sample consisted of 526 adult participants receiving PMHC-treatment in the municipalities of Sandnes and Kristiansand, between November 2015 to August 2017. Using logistic regression, we investigated the association between nine client characteristics and dropout. RESULTS The dropout rate was 25.3%. The adjusted analysis indicated that older clients had a lower odds ratio (OR) of dropping out compared to younger clients (OR = 0.43, [95% CI = 0.26, 0.71]). Moreover, clients with higher education had a lower odds ratio of dropping out compared to clients with lower levels of education (OR = 00.55, 95% CI [0.34, 0.88]), while clients who were unemployed were more likely to drop-out as compared the regularly employed (OR = 2.30, [95% CI = 1.18, 4.48]). Finally, clients experiencing poor social support had a higher odds ratio of dropping out compared to clients who reported good social support (OR = 1.81, [95% CI = 1.14, 2.87]). Sex, immigrant background, daily functioning, symptom severity and duration of problems did not predict dropout. CONCLUSION The predictors found in this prospective study might help PMHC-therapists identify clients at risk of dropout. Strategies for preventing dropout are discussed.
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Affiliation(s)
- Elin Hanevik
- Søndre Oslo DPS, Helga Vaneks Vei 6, 1281, Oslo, Norway
| | - Frida M G Røvik
- Rask Psykisk Helsehjelp, Bydel Ullern, Hoffsveien 48, 0377, Oslo, Norway
| | - Tormod Bøe
- Department of Psychosocial Science, The University of Bergen, Christies Gate 12, 5015, Bergen, Norway
- RKBU Vest, NORCE Norwegian Research Centre, Bergen, Norway
| | - Marit Knapstad
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway
| | - Otto R F Smith
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway.
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway.
- Department of Teacher Education, NLA University College, Pb 74 Sandviken, 5812, Bergen, Norway.
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Hellstern RB, Robinson WD. The Impact of COVID-19 and Telehealth Services on Attrition Rates in Psychotherapy. CONTEMPORARY FAMILY THERAPY 2023; 45:1-12. [PMID: 36711078 PMCID: PMC9873205 DOI: 10.1007/s10591-023-09661-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/25/2023]
Abstract
Attrition in psychotherapy has been identified as a significant obstacle in the productive delivery of mental health services. Defined generally as the ending of a treatment prior to proper optimal benefit, attrition both hinders treatment efficacy and costeffectiveness in therapy. With the demands for quality mental health services increasing, resources must be identified to reduce barriers to such services. The COVID-19 pandemic has resulted in the emergence of one potential resources: telehealth services. The current study aims to identify how COVID-19 and telehealth services have influenced attrition by analyzing attrition rates from both before and during the pandemic in a community health center where a transition to telehealth was made at the start of the pandemic. In addition, the variables of age, gender, socioeconomic status, and insurance coverage were also tested as potential predictors of attrition. Using de-identified patient information, clients who had participated in therapy services within a six-month period at a community health center (N = 329) were selected. A survival analysis was used to assess the time taken from initial appointment to the point of attrition. Results indicated that those who attended therapy via telehealth were less likely to stop attending treatment than those who participated in therapy in person. Individuals who used both in-person and telehealth visits were the least likely to terminate treatment prematurely. Clinical implications include the need for therapists to offer both telehealth and in-person services in order to give clients more resources to reduce a large barrier to needed mental healthcare treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s10591-023-09661-0.
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Affiliation(s)
- Rylan B. Hellstern
- Department of Human Development and Family Studies, Utah State University, Logan, UT USA
| | - W. David Robinson
- Department of Human Development and Family Studies, Utah State University, Logan, UT USA
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4
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Booysen DD, Kagee A. Trauma survivors' perceptions and experiences of prolonged exposure for PTSD at a psychology clinic. S Afr J Psychiatr 2023; 29:1869. [PMID: 36876034 PMCID: PMC9982501 DOI: 10.4102/sajpsychiatry.v29i0.1869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 10/11/2022] [Indexed: 03/05/2023] Open
Abstract
Background Several trauma-focused treatments have been developed to treat post-traumatic stress disorder (PTSD). Yet there are limited studies on how trauma survivors perceive and experience trauma-focused treatments such as prolonged exposure therapy (PE) for PTSD, especially in low- and middle-income countries (LMIC). Aim The study aimed to explore the perceptions and experiences of trauma survivors receiving prolonged exposure therapy for PTSD and the general acceptability of PE for PTSD in a LMIC. Setting The study was conducted at a community psychology clinic in the Eastern Cape, South Africa. Method Using a qualitative method, seven adult trauma survivors who completed six sessions of brief PE for PTSD were interviewed. Thematic analysis was used to identify relevant themes and to understand how participants perceived and experienced PE for PTSD. Results The analysis yielded five themes, namely structure, obstacles, gender, exposure and experiences of recovery. Conclusion The findings suggested that participants perceived and experienced PE to be generally beneficial for the treatment of PTSD. Moreover, the study suggested that PE is an acceptable trauma therapy in a contextually diverse setting such as the Eastern Cape, South Africa. Overall, considering the evidence base of PE for PTSD, this study contributed to the literature on the acceptability of PE in a South African setting. Contribution The findings of the study are in keeping with the extant literature on how persons perceive and experience PE for PTSD. The findings of the study suggests that PE is an acceptable and beneficial trauma therapy for PTSD in a contextually diverse setting such as South Africa. It is recommended that large scale implementation studies be conducted to further investigate the effectiveness, feasibility, and acceptability of PE in South Africa.
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Affiliation(s)
- Duane D Booysen
- Department of Psychology, Faculty of Humanities, Rhodes University, Grahamstown, South Africa
| | - Ashraf Kagee
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
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5
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Blaauw E, Venema SD, Muskee L. Nonattendance in addiction mental health services: Patient and appointment factors. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2022. [DOI: 10.1002/jaoc.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Eric Blaauw
- Verslavingszorg Noord Nederland Groningen The Netherlands
- Research Group of Addiction Science and Forensic Care Hanze University of Applied Sciences Groningen The Netherlands
| | - Simon D. Venema
- Verslavingszorg Noord Nederland Groningen The Netherlands
- Research Group of Addiction Science and Forensic Care Hanze University of Applied Sciences Groningen The Netherlands
| | - Liza Muskee
- Verslavingszorg Noord Nederland Groningen The Netherlands
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6
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Granås J, Strand J, Sand P. A patient perspective on non-attendance for psychotherapy in psychiatric outpatient care for patients with affective disorders. NORDIC PSYCHOLOGY 2022. [DOI: 10.1080/19012276.2022.2093777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Janne Granås
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jennifer Strand
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
| | - Peter Sand
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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7
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Holmberg Bergman T, Renhorn E, Berg B, Lappalainen P, Ghaderi A, Hirvikoski T. Acceptance and Commitment Therapy Group Intervention for Parents of Children with Disabilities (Navigator ACT): An Open Feasibility Trial. J Autism Dev Disord 2022; 53:1834-1849. [PMID: 35239083 PMCID: PMC10123046 DOI: 10.1007/s10803-022-05490-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
Parents of children with autism spectrum disorder and other disabilities report high levels of distress, but systematically evaluated interventions are few. This study aimed to evaluate the feasibility of a novel, manualized Acceptance and Commitment Therapy group intervention (Navigator ACT) in a sample of 94 parents of children with disabilities. Feasibility was measured by treatment completion, credibility, and satisfaction, and preliminary outcomes by using self-rating scales administered at the baseline, post-intervention, and follow-up. The results imply the intervention is feasible in the context of Swedish outpatient habilitation services. A preliminary analysis of the outcome measures suggests that parents experienced significant improvements in well-being. The results indicate that the treatment is feasible and should be evaluated in a randomized controlled trial.
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Affiliation(s)
- T Holmberg Bergman
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Gävlegatan 22B, 11330, Stockholm, Sweden. .,Habilitation and Health, Region Stockholm, Stockholm, Sweden. .,Center for Psychiatry Research, Stockholm, Sweden.
| | - E Renhorn
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Gävlegatan 22B, 11330, Stockholm, Sweden.,Habilitation and Health, Region Stockholm, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm, Sweden
| | - B Berg
- Habilitation and Health, Region Stockholm, Stockholm, Sweden
| | - P Lappalainen
- Department of Psychology, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland
| | - A Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 17165, Stockholm, Sweden
| | - T Hirvikoski
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Gävlegatan 22B, 11330, Stockholm, Sweden.,Habilitation and Health, Region Stockholm, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm, Sweden
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8
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Baño M, Mestre-Bach G, Granero R, Fernández-Aranda F, Gómez-Peña M, Moragas L, Del Pino-Gutierrez A, Codina E, Guillén-Guzmán E, Valero-Solís S, Lizbeth Lara-Huallipe M, Baenas I, Mora-Maltas B, Valenciano-Mendoza E, Solé-Morata N, Gálvez-Solé L, González-Bueso V, José Santamaría J, Menchón JM, Jiménez-Murcia S. Women and gambling disorder: Assessing dropouts and relapses in cognitive behavioral group therapy. Addict Behav 2021; 123:107085. [PMID: 34425460 DOI: 10.1016/j.addbeh.2021.107085] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/02/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gender-specific literature focused on gambling disorder (GD) is scarce, and women with GD have been understudied. Therefore, the aim of this study was to estimate the short-term effectiveness in women with GD (n = 214) of a group standardized cognitive-behavioral therapy (CBT) and to identify the most relevant predictors of the primary therapy outcomes (dropout and relapse). METHODS The manualized CBT consisted of 16 weekly outpatient group sessions. Women were provided with resources to obtain a better understanding of the GD, to improve self-control and to manage risk situations. RESULTS The dropout risk was higher for women with lower GD severity and higher psychopathological distress. Among other factors, lower education levels were a significant predictor of the relapse risk and and the frequency of relapses was higher for divorced women with a preference for non-strategic gambling and with substances consumption. CONCLUSIONS Our findings evidence women-specific predictors of the primary therapy outcomes. The results highlight the need to design psychological interventions that address dropout and relapse risk factors in women.
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Affiliation(s)
- Marta Baño
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Atención e Investigación en Socioadicciones (AIS), Mental Health and Addictions Network. Generalitat de Catalunya (XHUB), Barcelona, Spain
| | | | - Roser Granero
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Amparo Del Pino-Gutierrez
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Nursing Department of Mental Health, Public Health, Maternal and Child Health, Nursing School, University of Barcelona, Barcelona, Spain
| | - Ester Codina
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Elías Guillén-Guzmán
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Susana Valero-Solís
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | | | - Isabel Baenas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Bernat Mora-Maltas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | | | - Neus Solé-Morata
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Laura Gálvez-Solé
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Vega González-Bueso
- Atención e Investigación en Socioadicciones (AIS), Mental Health and Addictions Network. Generalitat de Catalunya (XHUB), Barcelona, Spain
| | - Juan José Santamaría
- Atención e Investigación en Socioadicciones (AIS), Mental Health and Addictions Network. Generalitat de Catalunya (XHUB), Barcelona, Spain
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Ciber Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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9
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Riisager LHG, Christensen AB, Scharff FB, Arendt IMTP, Ismail I, Lau ME, Moeller SB. Patients' Experiences of Using a Self-help App for Posttraumatic Stress Disorder: Qualitative Study. JMIR Form Res 2021; 5:e26852. [PMID: 34346896 PMCID: PMC8374664 DOI: 10.2196/26852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/23/2021] [Accepted: 05/16/2021] [Indexed: 01/19/2023] Open
Abstract
Background Posttraumatic stress disorder (PTSD) is a common disorder that requires more treatment options. Mobile health (mHealth) app interventions are promising for patients with PTSD, as they can provide easily accessible support, strategies, and information. However, knowledge about mHealth interventions is sparse and primarily based on quantitative studies. Objective The aim of this study is to qualitatively explore the experiences of patients with PTSD with regard to using an mHealth app as a stand-alone intervention before commencing psychotherapeutic treatment. Methods We conducted semistructured interviews with 14 participants 6 weeks after they received the app. The participants were all referred to PTSD treatment and were waiting to commence psychotherapeutic treatment. During this waiting time, the participants had no contact with the health staff. Interviews were transcribed and were analyzed using thematic analysis. Results A total of 3 themes were identified—the use of app, being a patient, and the overall evaluation of the app. The use of the app was described with the subtheme of habits, and the theme of being a patient included the subthemes of having negative experiences with the app and being a part of a research project. The use of the app encompassed how psychological factors and technical problems could interfere with the use of the app. The theme of being a patient depicted that the waiting time before starting treatment was long, and a subgroup of patients experienced feeling worse during this time, which they partly attributed to using the app. Several suggestions for change have been described in the overall evaluation of the app. Conclusions The findings in this study revealed that emotional arousal influenced the use of the app and that it was difficult for participants to establish a habit of using the app, thus reflecting the importance of supporting habit formation when implementing an mHealth app in mental health care services. This study makes an important contribution to the field of mHealth research, as it revealed that some participants had negative experiences resulting from using the app, thus reflecting the potential harm of having an mHealth app without the support of a clinician. It is therefore recommended to use a blended care treatment or an approach in which mental health care professionals prescribe an mHealth app for relevant patients to avoid increased suicidal risk.
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Affiliation(s)
- Lisa H G Riisager
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Mental Health Services West, Region Zealand, Slagelse, Denmark
| | - Frederik Bernt Scharff
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark
| | - Ida-Marie T P Arendt
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark
| | - Israa Ismail
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark
| | - Marianne Engelbrecht Lau
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark
| | - Stine Bjerrum Moeller
- Unit for Psychotherapy Research, Stolpegaard Psychotherapy Centre, Mental Health Services Capital Region of Denmark, Gentofte, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
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10
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Lu SHX, Assudani HA, Kwek TRR, Ng SWH, Teoh TEL, Tan GCY. A Randomised Controlled Trial of Clinician-Guided Internet-Based Cognitive Behavioural Therapy for Depressed Patients in Singapore. Front Psychol 2021; 12:668384. [PMID: 34393903 PMCID: PMC8359863 DOI: 10.3389/fpsyg.2021.668384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
This study examined the efficacy and acceptability of a hybrid, clinician-guided internet-based Cognitive Behavioural Therapy (iCBT) programme for outpatients with depression in a psychiatric hospital in Singapore. Fifty three participants were randomly assigned to a treatment or wait-list control group before they underwent a cross-over of conditions. Treatment consisted of a 4-week iCBT with three face-to-face sessions. 60.9% of participants who received treatment completed all six modules. Intention-to-treat analysis showed treatment was associated with significant reductions in symptoms of depression, anxiety and psychological distress but not in functional impairment, while the control condition was not associated with changes in any measures. These reductions had moderate to large effect sizes (ESs) for symptoms of depression and anxiety, and moderate ES for psychological distress. The between-group difference in depression score had a moderate ES. There was a significant between-group treatment effect in depressive symptoms, but not in the other measures. Treatment gains were maintained at 3-month follow-up. Most of the participants were highly satisfied with the programme, with 90 percent stating they would recommend it. This is the first RCT to provide preliminary evidence for the efficacy and acceptability of iCBT for depression in Singapore.
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Affiliation(s)
- Sharon H X Lu
- Department of Psychology, Institute of Mental Health, Singapore, Singapore
| | - Hanita A Assudani
- Department of Psychology, Institute of Mental Health, Singapore, Singapore
| | - Tammie R R Kwek
- Department of Psychology, Institute of Mental Health, Singapore, Singapore
| | - Shaun W H Ng
- Department of Psychology, Institute of Mental Health, Singapore, Singapore
| | - Trisha E L Teoh
- Department of Psychology, Institute of Mental Health, Singapore, Singapore
| | - Geoffrey C Y Tan
- Department of Mood and Anxiety, Institute of Mental Health, Singapore, Singapore.,Singapore Institute of Clinical Sciences, Agency for Science Technology and Research (ASTAR), Singapore, Singapore.,Clinical Imaging Research Centre, Yong Loo Lin Medical School, National University of Singapore, Singapore, Singapore
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11
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Park KH, Park ES, Jo SM, Seo MH, Song YO, Jang SJ. Effects of a Short Emotional Management Program on Inpatients with Schizophrenia: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105497. [PMID: 34065556 PMCID: PMC8160633 DOI: 10.3390/ijerph18105497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 12/26/2022]
Abstract
The prevalence of schizophrenia is gradually increasing worldwide. Many patients with schizophrenia have a diminished ability to empathize and to detect their own emotions or those of others, deteriorating their social functioning and their quality of life. Nonetheless, emotional management training may improve patients' emotion recognition, emotional expression, and negative symptoms. Developing and applying a short but effective program that reflects the current medical environment, in which hospital stays are ever-diminishing, is warranted. This one-group, pretest-posttest, quasi-experimental pilot study aimed to examine the effects of a short emotional management program (EMP-S) on 17 patients with chronic schizophrenia. Participants were patients hospitalized in the National Center for Mental Health in Korea. After the completion of a twice-a-week, eight-session, four-week long EMP-S, participants showed improvements in emotion recognition, emotional expression, and negative symptoms. Our results suggest the applicability and potential effectiveness of the EMP-S, which takes the length of psychiatric hospital stay and the inpatient environment into consideration. To minimize any barriers to social functioning in the post-discharge lives of inpatients with chronic schizophrenia and enhance their social cognition-by improving their emotion recognition, emotional expression, and negative symptoms-we suggest the periodical administration of this EMP-S to these inpatients.
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Affiliation(s)
- Kyung-Hwan Park
- National Center for Mental Health, 127, Yongmasan-ro, Gwangjin-gu, Seoul 04933, Korea; (K.-H.P.); (E.-S.P.); (S.-M.J.); (M.-H.S.); (Y.-O.S.)
| | - Eun-Sook Park
- National Center for Mental Health, 127, Yongmasan-ro, Gwangjin-gu, Seoul 04933, Korea; (K.-H.P.); (E.-S.P.); (S.-M.J.); (M.-H.S.); (Y.-O.S.)
| | - Sung-Mi Jo
- National Center for Mental Health, 127, Yongmasan-ro, Gwangjin-gu, Seoul 04933, Korea; (K.-H.P.); (E.-S.P.); (S.-M.J.); (M.-H.S.); (Y.-O.S.)
| | - Mi-Hui Seo
- National Center for Mental Health, 127, Yongmasan-ro, Gwangjin-gu, Seoul 04933, Korea; (K.-H.P.); (E.-S.P.); (S.-M.J.); (M.-H.S.); (Y.-O.S.)
| | - Young-Ok Song
- National Center for Mental Health, 127, Yongmasan-ro, Gwangjin-gu, Seoul 04933, Korea; (K.-H.P.); (E.-S.P.); (S.-M.J.); (M.-H.S.); (Y.-O.S.)
| | - Sun-Joo Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea
- Correspondence: ; Tel.: +82-10-3223-8667
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Fornaro M, Novello S, Fusco A, Anastasia A, De Prisco M, Mondin AM, Mosca P, Iasevoli F, de Bartolomeis A. Clinical features associated with early drop-out among outpatients with unipolar and bipolar depression. J Psychiatr Res 2021; 136:522-528. [PMID: 33127073 DOI: 10.1016/j.jpsychires.2020.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/08/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
Drop-out from follow-up visits carries significant burden for people diagnosed with depression. The present study assesses multiple clinical moderators of drop-out among depressed outpatients. We retrospectively followed-up 131 outpatients over 6 months: 78 major depressive disorder (MDD), and 53 bipolar disorder (BD-I = 24; BD-II = 29) patients diagnosed according to the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. Participants were assessed with standard rating scales administered by experienced psychiatrists. Upon descriptive and Cox regression analyses, 17/53 BDs (32%) dropped-out; the overall survival time until drop-out was 57.94 ± 17.79 days. BD drop-outs were younger, had an earlier age at onset, shorter illness duration, lower rates of lifetime obsessive-compulsive disorder/suicidal behavior, higher rates of substance use disorder (SUD), anxious and mixed features of depression compared to BDs attending up to six months. Among MDD patients, 10/78 cases (13%) dropped-out by month-6 with an average survival of 42.40 ± 16.45 days. Earlier age of onset, younger age, positive family history for mood disorders, lower rates of lifetime generalized anxiety disorder were significantly more frequent among drop-outs than completers, as opposite to SUD, and lifetime recurrent depression. Older age predicted lower drop-out among BDs and MDDs, although with almost null hazard ratio (HR) = 0.928, p < 0.01 vs. HR = 0.941, p < 0.01, respectively. Higher rates of lifetime SUD predicted higher drop-out rates by month-6 among MDDs (HR = 5.477, p = 0.02). Limitations of the study: retrospective design, small sample size, lack of objective measures of treatment-adherence/mood rating during follow-up. Drop-out is common in the real-world setting, warranting specific interventions since the beginning of the treatment.
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Affiliation(s)
- M Fornaro
- Section of Psychiatry - Unit on Treatment-Resistant Disorders, Department of Neuroscience, Reproductive Sciences, and Dentistry, University School of Medicine Federico II, Naples, Italy.
| | - S Novello
- National Healthcare System, Milan, Italy.
| | - A Fusco
- National Healthcare System, Naples, Italy.
| | | | - M De Prisco
- Section of Psychiatry - Unit on Treatment-Resistant Disorders, Department of Neuroscience, Reproductive Sciences, and Dentistry, University School of Medicine Federico II, Naples, Italy.
| | - A M Mondin
- Section of Psychiatry - Unit on Treatment-Resistant Disorders, Department of Neuroscience, Reproductive Sciences, and Dentistry, University School of Medicine Federico II, Naples, Italy.
| | - P Mosca
- Section of Psychiatry - Unit on Treatment-Resistant Disorders, Department of Neuroscience, Reproductive Sciences, and Dentistry, University School of Medicine Federico II, Naples, Italy.
| | - F Iasevoli
- Section of Psychiatry - Unit on Treatment-Resistant Disorders, Department of Neuroscience, Reproductive Sciences, and Dentistry, University School of Medicine Federico II, Naples, Italy.
| | - A de Bartolomeis
- Section of Psychiatry - Unit on Treatment-Resistant Disorders, Department of Neuroscience, Reproductive Sciences, and Dentistry, University School of Medicine Federico II, Naples, Italy.
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Munasinghe S, Page A, Mannan H, Ferdousi S, Peek B. Determinants of treatment disengagement among those at risk of suicide referred to primary mental health care services in Western Sydney, Australia. Aust N Z J Psychiatry 2021; 55:277-288. [PMID: 33032444 DOI: 10.1177/0004867420963738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Continued engagement with primary mental health services has been associated with the prevention of subsequent suicidal behaviour; however, there are few studies that identify determinants of treatment disengagement among those at risk of suicide in primary care settings. This study investigated determinants of treatment disengagement of those at risk of suicide who were referred to primary mental health care services in Western Sydney, Australia. METHOD This study used routinely collected data of those referred for suicide prevention services provided through primary mental health care services between July 2012 and June 2018. Associations between sociodemographic, diagnostic, referral- and service-level factors and treatment non-attendance and early treatment cessation were investigated using a series of multivariable generalised estimation equations. RESULTS There were 1654 suicidal referrals for 1444 people during the study period. Those identified with a risk of suicide were less likely to never attend treatments (16.14% vs 19.77%), but were more likely to disengage earlier from subsequent service sessions (16.02% vs 12.41%), compared to those with no risk of suicide. A higher likelihood of non-attendance to any primary mental health care service sessions was associated with those aged 25-44, lower socioeconomic status, a presentation for substance use and a referral from acute care (either emergency department or hospital). Among those who attended an initial treatment session, younger age (18-24 years) and a longer waiting time for an initial follow-up appointment were associated with a higher likelihood of early treatment cessation from primary mental health care services. CONCLUSION These findings can inform potential strategies in routine primary mental health care practice to improve treatment engagement among those at risk of suicidal behaviour. Youth-specific interventions, behavioural engagement strategies and prompt access to services are policy and service priorities.
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Affiliation(s)
- Sithum Munasinghe
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,Western Sydney Primary Health Network, Blacktown, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Haider Mannan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Shahana Ferdousi
- Western Sydney Primary Health Network, Blacktown, NSW, Australia
| | - Brendan Peek
- Royal Australasian College of Dental Surgeons, Sydney, NSW, Australia
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Brunnbauer L, Simpson S, Balfour C. Exploration of Client Profile and Clinical Outcome in a University Psychology Clinic. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Susan Simpson
- Department of Psychology, University of South Australia,
| | - Cathy Balfour
- Department of Psychology, University of South Australia,
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Munasinghe S, Page A, Mannan H, Ferdousi S, Peek B. Determinants of treatment non-attendance among those referred to primary mental health care services in Western Sydney, Australia: a retrospective cohort study. BMJ Open 2020; 10:e039858. [PMID: 33109673 PMCID: PMC7592298 DOI: 10.1136/bmjopen-2020-039858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Recommendations of the recent mental health reforms provided an opportunity to implement regional approaches to service provision through Primary Health Networks. This study is designed to identify the determinants of sociodemographic, diagnostic and referral-level factors and first treatment session non-attendance among those referred to primary mental health care (PMHC) services in Western Sydney, Australia. DESIGN This study used routinely collected retrospective PMHC data between July 2016 and December 2018. SETTING The study was based on a geographical catchment that covers four local government areas of Blacktown, Parramatta, Cumberland and Hills Shire in Western Sydney, Australia. PARTICIPANTS All individuals 5 years of age or older referred to PMHC services. PRIMARY OUTCOME MEASURE First treatment session non-attendance, following a referral to receive psychological treatments. RESULTS There were 9158 referrals received for 8031 clients, with 1769 (19.32%) referrals resulting in non-attendance to the first treatment session. Those with younger age (ORs ranging from 1.63 to 1.92), substance use (OR=1.55, 95% CI 1.17 to 2.06), poor English proficiency (OR=1.64, 95% CI 1.23 to 2.20), lower socioeconomic status (OR=1.57, 95% CI 1.34 to 1.83), psychotropic medication use (OR=1.20, 95% CI 1.06 to 1.36), and a referral by a social worker (OR=2.04, 95% CI 1.36 to 3.05), allied health (OR=1.49, 95% CI 1.03 to 2.16) or other professional (OR=1.72, 95% CI 1.30 to 2.29) were associated with a higher likelihood of first treatment session non-attendance. Those with a risk of suicide, who mainly speak a language other than English, and a previous use of PMHC services were more likely to attend their first treatment session. CONCLUSION Youth-specific treatment approaches, behavioural engagement strategies, facilitation of transport services for those live in deprived regions and improvements in capacity for mental health training among allied health professionals are areas of focus for primary care service and policy responses.
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Affiliation(s)
- Sithum Munasinghe
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Haider Mannan
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Shahana Ferdousi
- Western Sydney Primary Health Network, Blacktown, New South Wales, Australia
| | - Brendan Peek
- Royal Australasian College of Dental Surgeons, Sydney, New South Wales, Australia
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16
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Houtepen JABM, Sijtsema JJ, Van der Lem R, Scheres A, Bogaerts S. Cognitive-motivational, interpersonal, and behavioral functioning in relationship to treatment and research engagement in forensic patients with ADHD. J Clin Psychol 2020; 76:2345-2371. [PMID: 32659042 PMCID: PMC7689781 DOI: 10.1002/jclp.23016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/31/2020] [Accepted: 06/06/2020] [Indexed: 02/04/2023]
Abstract
Objectives To provide more insight into treatment and research responsivity in offenders with attention‐deficit hyperactivity disorder (ADHD). Method Via self‐reports and patients' scores on cognitive computer tasks, it was examined whether poorer cognitive‐motivational, interpersonal, and behavioral functioning were related to treatment no‐shows, longer treatment time duration intervals, and no‐show at the research appointment in 52 forensic outpatients with ADHD (Mage = 35.3, SD = 9.38). Treatment adherence was tracked for 10 appointments after research participation. Results Regression analyses showed that higher self‐reported impulsivity was associated with research no‐show, and more alcohol use with longer treatment time intervals. Yet, self‐reported delay aversion was associated with fewer treatment no‐shows, and, uncontrolled for alcohol use, impulsivity was associated with shorter treatment time intervals in a subsample of patients. Conclusions These preliminary results indicate that externalizing behaviors increase the risk for nonadherence in forensic ADHD patients, but that cognitive‐motivational problems also motivate patients to be more engaged.
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Affiliation(s)
- Jenny A B M Houtepen
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands.,Department of Developmental Psychology, School of Social and Behavioral Sciences, Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jelle J Sijtsema
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands.,Department of Developmental Psychology, School of Social and Behavioral Sciences, Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Rosalind Van der Lem
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands
| | - Anouk Scheres
- Department of Developmental Psychology, Radboud University, Radboud, The Netherlands
| | - Stefan Bogaerts
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands.,Department of Developmental Psychology, School of Social and Behavioral Sciences, Developmental Psychology, Tilburg University, Tilburg, The Netherlands
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Predictors of participant ‘no-shows’ for intensive behavioral tobacco cessation treatment: recruitment, demographics, and distance. J Smok Cessat 2020. [DOI: 10.1017/jsc.2020.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AbstractIntroductionCognitive-behavioral therapy (CBT) for tobacco cessation is an evidence-based, yet underutilized intervention. More research is needed to understand why some treatment-seekers are ‘no-shows’ for the initial visit.AimExamine factors associated with participant no-shows among smokers scheduled for group CBT.MethodsTobacco smokers (N = 115) were recruited from the community, screened, and if eligible, scheduled to begin group-based CBT plus nicotine replacement therapy. At the screening, participants reported their recruitment source, demographics, smoking history, and contact information. We computed the distance to the study site using the address provided. Regression analyses tested predictors of participant no-shows for the initial visit.ResultsEligible participants were mostly recruited via flyers (56%), female (58%), African American (61%), middle-aged (Mage = 49 years), averaged 16 cigarettes per day, and resided 8 miles away from the study site. The overall initial visit no-show rate was 56%. Bivariate analyses indicated that respondents who were recruited online, younger, and lived further away from the site were more likely to be no-shows. Younger age significantly predicted failure to attend in the multivariable model.ConclusionsFindings highlight potential barriers to participation in a group-based intervention, and have implications for pre-intervention engagement strategies and modifications that may increase reach and uptake.
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Cho M, Jang SJ. Effect of an emotion management programme for patients with schizophrenia: A quasi-experimental design. Int J Ment Health Nurs 2019; 28:592-604. [PMID: 30585413 DOI: 10.1111/inm.12565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2018] [Indexed: 11/30/2022]
Abstract
One of the goals of psychiatric social rehabilitation treatment is to improve patients' emotion recognition, emotional expression, and empathetic abilities. In this study, we used a quasi-experimental, nonrandomized design to examine the effect of an emotion management programme on the emotion recognition (emotion attention and emotion clarity), emotional expression (positive expressivity, negative expressivity, and impulse strength), and quality of life (QoL) of a sample of patients with schizophrenia in South Korea. Over eight sessions, we collected data from 56 patients with schizophrenia registered in community mental rehabilitation facilities. After attending the emotion management programme, the emotion recognition, emotional expression, and QoL scores of the experimental group were found to have significantly increased, whereas those of the control group had significantly decreased. Therefore, our findings show that emotion management programmes can be used as nursing interventions to improve the QoL of people with schizophrenia.
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Affiliation(s)
- Minju Cho
- Graduate School of Advanced Nursing Practice, Eulji University, Daejeon, South Korea
| | - Sun Joo Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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Firth N, Delgadillo J, Kellett S, Lucock M. The influence of socio-demographic similarity and difference on adequate attendance of group psychoeducational cognitive behavioural therapy. Psychother Res 2019; 30:362-374. [DOI: 10.1080/10503307.2019.1589652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Nick Firth
- Clinical Psychology Unit, University of Sheffield, Sheffield, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jaime Delgadillo
- Clinical Psychology Unit, University of Sheffield, Sheffield, UK
| | - Stephen Kellett
- Clinical Psychology Unit, University of Sheffield, Sheffield, UK
| | - Mike Lucock
- Centre for Applied Research in Health, University of Huddersfield, Huddersfield, UK
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
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Dilgul M, McNamee P, Orfanos S, Carr CE, Priebe S. Why do psychiatric patients attend or not attend treatment groups in the community: A qualitative study. PLoS One 2018; 13:e0208448. [PMID: 30543646 PMCID: PMC6292613 DOI: 10.1371/journal.pone.0208448] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/16/2018] [Indexed: 12/24/2022] Open
Abstract
Background Non-attendance of treatment groups in the community has been a long-standing problem in mental health care. It has been found to have financial ramifications for services, worsen outcomes for those that do not attend and negatively impact on therapeutic group processes. There is a need to gain a better understanding of patients’ reasons for attending or not attending. This study aimed to explore patient views on facilitators and barriers to the attendance of treatment groups in the community. Methods The study used interview data collected as part of three studies that investigated treatment groups for psychiatric patients in the community. Sixty-seven interview transcripts were analysed using the framework method. Results Five themes relating to facilitators of group attendance were identified: opportunity for autonomy; self-acknowledging need and therapist encouragement; optimal group format and safe environment; interest in content and enjoyment; actual and expected benefits of attendance. Four themes related to barriers: not being sufficiently informed; concerns about social interactions and the unknown; limited accessibility; and negative group dynamics. Conclusion To facilitate attendance and reduce attrition to treatment groups in the community clinicians should address patient’s wishes for information, capture their interest in the group modality, and potentially offer a ‘trial’ session. Furthermore, they should make the group location and time as accessible as possible and create a moderately sized group of six to eight patients. In these groups, mutual respect, feelings of safety and encouragement appear essential to make patients feel they can benefit from attendance.
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Affiliation(s)
- Merve Dilgul
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
- * E-mail:
| | - Philip McNamee
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Stavros Orfanos
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Catherine Elizabeth Carr
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
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Hundt NE, Ecker AH, Thompson K, Helm A, Smith TL, Stanley MA, Cully JA. "It didn't fit for me:" A qualitative examination of dropout from prolonged exposure and cognitive processing therapy in veterans. Psychol Serv 2018; 17:414-421. [PMID: 30475041 DOI: 10.1037/ser0000316] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Trauma-focused psychotherapies, such as prolonged exposure and cognitive processing therapy, are the most effective forms of treatment for posttraumatic stress disorder. These treatments are commonly delivered in the Veterans Health Administration; however, dropout means that some veterans fail to benefit. Ending treatment prematurely is a common problem across psychotherapies, with on average, 20% to 25% of patients dropping out. The purpose of this study was to examine veterans' self-reported reasons for dropping out of prolonged exposure or cognitive processing therapy. Veterans who dropped out from prolonged exposure or cognitive processing therapy (N = 28) completed qualitative interviews about their experiences. Interviews were coded by 2 coders using grounded theory. Therapy-related barriers were the largest category reported, and included lack of buy-in to the rationale or specific therapy tasks, believing that treatment was not working, alliance issues, or switching to a different treatment. Practical barriers and finding treatment "too stressful" were also common reasons for dropout. This research provides information that can shape how PTSD treatments are delivered in health care settings. Therapy-related barriers were the largest group, suggesting that providers may need to find more effective ways to communicate the rationale for these therapies or to tailor them to individual patients' needs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Natalie E Hundt
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Anthony H Ecker
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | | | - Ashley Helm
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Tracey L Smith
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Melinda A Stanley
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Jeffrey A Cully
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
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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.
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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
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Florer KJ, Prieto L. College Students’ Likelihood of “no-showing” for an Initial Hypothetical Counseling Appointment. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2018. [DOI: 10.1080/87568225.2017.1413321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Loreto Prieto
- Department of Psychology, Iowa State University, Ames, Iowa, USA
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Schawohl A, Odenwald M. Häufigkeit und Risikofaktoren des Therapieabbruchs in einer verhaltenstherapeutischen Hochschulambulanz: Der Einfluss von riskantem Alkoholkonsum zu Therapiebeginn. VERHALTENSTHERAPIE 2018. [DOI: 10.1159/000492086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Predictors of Disparities in Access and Retention in School-Based Mental Health Services. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-017-9233-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Grover S, Dua D, Chakrabarti S, Avasthi A. Dropout rates and factors associated with dropout from treatment among elderly patients attending the outpatient services of a tertiary care hospital. Indian J Psychiatry 2018; 60:49-55. [PMID: 29736062 PMCID: PMC5914262 DOI: 10.4103/psychiatry.indianjpsychiatry_410_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM This study aimed to evaluate the "dropout" rates from treatment and associated factors among elderly patients attending a tertiary care psychiatry outpatient facility. MATERIALS AND METHODS Data of 1422 patients aged ≥60 years, attending the walk-in clinic were evaluated. RESULTS Out of 1422 patients, 406 (28.55%) belonged to the "dropout" group. In the "dropout" group, the age of patients was significantly higher than the followed-up group, and a higher proportion of patients were >70 years old. Significantly lower proportion of patients with diagnosis of depressive disorders belonged to the "dropout" group and significantly higher proportion of patients with "other" diagnoses belonged to the dropped out group. In patients with depressive disorders, a higher proportion of the patients in the "dropout" group were Hindu by religion (68.7% vs. 58.7%; χ2 = 4.26; P = 0.03). In patients with bipolar disorder, patients in the "dropout" group had significantly higher income (Rs. 13,323 [standard deviation [SD] = 16,769] vs. 5681 [SD = 9422]; t-test value: 2-25; P = 0.028) and lesser proportion of patients were of the male gender (63.15 vs. 86.95%; Mann-Whitney U value = 257.5; P = 0.039). In the group of other diagnoses, a higher proportion of patients in the "dropout" group were currently single (32.3% vs. 18.7%; χ2 = 4.12; P = 0.042), from rural locality (63.1% vs. 46.72%; χ2 = 4.33; P = 0.037) and were not prescribed medications (40% vs. 22.4%; χ2 = 6.05; P = 0.04). CONCLUSION Dropout from treatment among elderly patients is associated with higher age, not being prescribed medications, and diagnosis other than the affective disorders, psychotic disorders, and the cognitive disorders.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devakshi Dua
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Workforce design in primary care-mental health integration: a case study at one veterans affairs medical center. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2015.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Clough BA, Nazareth SM, Casey LM. The Therapy Attitudes and Process Questionnaire: A Brief Measure of Factors Related to Psychotherapy Appointment Attendance. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:237-250. [PMID: 27718132 DOI: 10.1007/s40271-016-0199-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient non-attendance and dropout remains problematic in mental health settings. The theory of planned behavior (TPB) has proven useful in understanding such challenges in a variety of healthcare settings, but the absence of an adequate measure in mental health has hampered research in this area. OBJECTIVE The aim of the current study was to develop and conduct an initial psychometric investigation of a brief measure, the Therapy Attitudes and Process Questionnaire (TAP), utilizing the TPB to understand factors associated with attendance in mental health settings. METHODS We used a quantitative survey-based design and administered the TAP to 178 adult participants who were engaged in individual or group psychotherapy. A subsample also provided data to assess validity and reliability. RESULTS A four-factor solution was revealed through exploratory factor analysis and accounted for approximately 75 % of the variance in scores. Factors corresponded to those predicted by the TPB. Analyses supported the reliability, validity, and internal consistency of the measure. CONCLUSIONS Results suggest that the TAP may be a useful tool for examining patients' attitudes and beliefs about attending psychotherapy appointments. The TAP can be used to better understand patients' intentions, attitudes, perceptions of behavioral control, and subjective norms relating to psychotherapy attendance. This understanding may facilitate improved outcomes for patients and clinicians.
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Affiliation(s)
- Bonnie A Clough
- School of Psychology and Counselling, Institute for Resilient Regions, University of Southern Queensland, 37 Sinnathamby Boulevard, Springfield Central, QLD, 4300, Australia.
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia.
| | - Sonia M Nazareth
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia
| | - Leanne M Casey
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia
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Hannibal N, Domingo MR, Valentin JB, Licht RW. Feasibility of Using the Helping Alliance Questionnaire II as a Self-Report Measure for Individuals with a Psychiatric Disorder Receiving Music Therapy. J Music Ther 2017; 54:287-299. [PMID: 28992114 DOI: 10.1093/jmt/thx009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background No specific instrument has been developed for measuring alliance during music therapy. Objective To evaluate the feasibility of using the Helping Alliance Questionnaire II (HAq-II) as a self-report measure for individuals receiving treatment for a psychiatric disorder. Specifically, we examined the percent of patients who filled out the questionnaire, and when completed, whether there were any missing items. We also examined internal consistency and associations between patient variables and HAq-II scores. Methods Between October 2013 and April 2014, we invited 45 individuals with a psychiatric disorder, who were also receiving music therapy, to fill out the HAq-II. We also collected clinical data from each person's record. Results Thirty-one (69%) of the 45 invited patients filled out the HAq-II, and of those completed, only three had missing items. Of the 45 invited patients, thirty (67%) had a diagnosis of schizophrenia or other psychotic disorders, and 11 (24%) were diagnosed with other psychiatric disorders. In terms of diagnosis and other clinical variables, no statistically significant differences were found between the 31 patients who filled out the HAq-II and the 14 patients who did not return the questionnaire. The median HAq-II score was 5.11 (range 3.74-6.00), indicating a relatively high alliance. We did not find any statistically significant associations between the HAq-II scores and potential predictors of interest. The Cronbach's alpha was 0.85. Conclusions Completion of the HAq-II was fairly high in this group of individuals with psychiatric diagnoses who were receiving music therapy. Internal consistency of the HAq-II was acceptable. Relatively high HAq-II scores suggest a high degree of therapeutic alliance, but the external validity of the HAq-II and the relationship between scores and therapy needs further evaluation.
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Affiliation(s)
- Niels Hannibal
- Aalborg University Hospital, Psychiatry.,Aalborg University, Institute for Communication and Psychology
| | | | | | - Rasmus W Licht
- Aalborg University Hospital, Psychiatry.,Aalborg University, Department of Clinical Medicine
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Simonsen S, Heinskou T, Sørensen P, Folke S, Lau ME. Personality disorders: patient characteristics and level of outpatient treatment service. Nord J Psychiatry 2017. [PMID: 28635555 DOI: 10.1080/08039488.2017.1284262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In this naturalistic study, patients with personality disorders (N = 388) treated at Stolpegaard Psychotherapy Center, Mental Health Services, Capital Region of Denmark were allocated to two different kinds of treatment: a standardized treatment package with a preset number of treatment hours (basic hospital service) and 2: a specialized treatment program for the most severely affected patients without a predetermined restricted number of treatment hours and significantly more individual psychotherapy (regional specialized hospital services). AIMS To investigate patient characteristics associated with clinicians' allocation of patients to the two different personality disorder services. METHODS Patient characteristics across eight domains were collected in order to study whether there were systematic differences between patients allocated to the two different treatments. Patient characteristics included measures of symptom severity, personality pathology, trauma and socio-demographic characteristics. Significance testing and binary regression analysis were applied to identify important predictors. RESULTS Patient characteristics on fifteen variables differed significantly, all in the expected direction, with patients in regional specialized hospital services showing more pathology and psychosocial problems. In the regression model, only age and two variables capturing psychosocial functioning remained significant predictors of allocation. DISCUSSION The finding that younger age was the most significant predictor of longer treatment replicates an earlier finding of allocation to treatment for personality disorder. Overall, this study therefore lends further support to the importance of demographic and social contextual factors in clinicians' allocation of patients to different treatment services for personality disorder.
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Affiliation(s)
| | - Torben Heinskou
- b Department of Personality Disorders and Trauma , Stolpegaard Psychotherapy Centre , Gentofte , Denmark
| | - Per Sørensen
- c Stolpegaard Psychotherapy Centre , Gentofte , Denmark
| | - Sofie Folke
- a Research Unit , Stolpegaard Psychotherapy Centre , Gentofte , Denmark
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Woicik K, van der Lem R, Sijtsema JJ, Bogaerts S. Treatment no-show in forensic outpatients with ADHD. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2017; 27:76-88. [PMID: 26887960 DOI: 10.1002/cbm.1989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 03/13/2015] [Accepted: 11/11/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND 'No-show' is important in today's mental healthcare services, yet in forensic psychiatry, little is known about its relationship to general and disorder-specific patient characteristics. AIMS The aim of this article is to determine the prevalence of no-show and any general and disorder-specific features associated with no-show in a cohort of offenders with attention deficit hyperactivity disorder registered at a specialist forensic mental health clinic. METHODS Participants were 118 adult men with a mean age just over 32 years (SD 8.75) attending forensic mental health outpatient clinics in the Netherlands who had a primary diagnosis of attention deficit hyperactivity disorder and who had been aggressive and/or delinquent. RESULTS Over a 1-year period, most patients (101, 86%) missed at least one appointment. The average number of appointments offered was 37.88 (SD = 27.27), and the average number of no-shows was 6.53 (SD = 5.99) per patient. Multivariate linear regressions showed a 10-fold likelihood of later no-shows if the first appointment was missed; not showing up after the intake procedure was also associated with higher rates of later no-show. None of the disorder-specific characteristics contributed to the problem. CONCLUSIONS No-show is of particular concern in forensic mental health settings. In the current study, no-show was primarily associated with features related to the time of initial consultation. More attention should thus be paid at this stage to using a standard method of assessing a wider range of variables likely to affect attendance. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kasja Woicik
- Forensic outpatient clinic het Dok Rotterdam (Fivoor) and Kijvelanden Academy of Research Innovation and Development (KARID), The Netherlands
| | - Rosalind van der Lem
- Forensic outpatient clinic het Dok Rotterdam (Fivoor) and Kijvelanden Academy of Research Innovation and Development (KARID), The Netherlands
| | - Jelle J Sijtsema
- Forensic outpatient clinic het Dok Rotterdam (Fivoor) and Kijvelanden Academy of Research Innovation and Development (KARID), The Netherlands
- Department of Developmental Psychology, Tilburg University, The Netherlands
| | - Stefan Bogaerts
- Forensic outpatient clinic het Dok Rotterdam (Fivoor) and Kijvelanden Academy of Research Innovation and Development (KARID), The Netherlands
- Department of Developmental Psychology, Tilburg University, The Netherlands
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Wyatt A, Shriki JE, Bhargava P. Dealing With No Shows: A Quality Improvement Initiative at a Tertiary Care Veterans Affairs Medical Center. J Am Coll Radiol 2016; 13:702-4. [DOI: 10.1016/j.jacr.2015.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/16/2015] [Indexed: 11/30/2022]
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Labrador FJ, Bernaldo-de-Quirós M, García-Fernández G, Estupiñá F, Fernández-Arias I, Labrador-Méndez M. Characteristics of demand and psychological treatments in a university clinic. CLÍNICA Y SALUD 2016. [DOI: 10.1016/j.clysa.2016.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Surgenor PWG, Meehan V, Moore A. Early attrition among suicidal clients. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2016. [DOI: 10.1080/03069885.2015.1134766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jiménez-Murcia S, Granero R, Fernández-Aranda F, Arcelus J, Aymamí MN, Gómez-Peña M, Tárrega S, Moragas L, Del Pino-Gutiérrez A, Sauchelli S, Fagundo AB, Brewin N, Menchón JM. Predictors of Outcome among Pathological Gamblers Receiving Cognitive Behavioral Group Therapy. Eur Addict Res 2015; 21:169-78. [PMID: 25832435 DOI: 10.1159/000369528] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/02/2014] [Indexed: 11/19/2022]
Abstract
AIMS The aim of this study was to evaluate posttreatment changes of individuals with a diagnosis of gambling disorder (GD) treated with group cognitive behavioral therapy (CBT), to assess the potential moderator effect of sex on CBT outcome, and to explore the best predictors of posttreatment changes, relapse, and dropout rates. METHODS A cohort design was applied with a prospective follow-up. The sample comprised 440 patients and the CBT intervention consisted of 16 weekly outpatient group sessions and a 3-month follow-up period. RESULTS Patients showed significant improvements in both the level of psychopathology and the severity of the gambling behavior. High self-transcendence and the involvement of the spouse or partner in the therapy predicted a higher risk of relapse. Younger age and low education predicted a higher risk of dropout. CONCLUSION Many patients with GD can be treated with strategies to improve self-control and emotional regulation, but other techniques should be incorporated to address the individual characteristics of each patient. This is particularly important in group therapy, in which the same treatment is applied to several patients simultaneously. The involvement of a family member needs to be carefully considered since it may have a negative effect on the response to treatment if not adequately managed.
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Affiliation(s)
- Susana Jiménez-Murcia
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
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Abstract
BACKGROUND. Drop-out from psychotherapy is common and represents a considerable problem in clinical practice and research. Aim. To explore pre-treatment predictors of early and late drop-out from psychodynamic group therapy in a public outpatient unit for non-psychotic disorders in Denmark. Methods. Naturalistic design including 329 patients, the majority with mood, neurotic and personality disorders referred to 39-session group therapy. Predictors were socio-demographic and clinical variables, self-reported symptoms (Symptom Check List-90-Revised) and personality style (Millon Clinical Multiaxial Inventory-II). Drop-out was classified into early and late premature termination excluding patients who dropped out for external reasons. Results. Drop-out comprised 20.6% (68 patients) of the sample. Logistic regression revealed social functioning, vocational training, alcohol problems and antisocial behavior to be related to drop-out. However, early drop-outs had prominent agoraphobic symptoms, lower interpersonal sensitivity and compulsive personality features, and late drop-outs cognitive and somatic anxiety symptoms and antisocial personality features. Clinical and psychological variables accounted for the major part of variance in predictions of drop-out, which ranged from 15.6% to 19.5% (Nagelkerke Pseudo R-Square). Conclusion. Social functioning was consistently associated with drop-out, but personality characteristics and anxiety symptoms differentiated between early and late drop-out. Failure to discriminate between stages of premature termination may explain some of the inconsistencies in the drop-out literature. Clinical implications. Before selection of patients to time-limited psychodynamic groups, self-reported symptoms should be thoroughly considered. Patients with agoraphobic symptoms should be offered alternative treatment. Awareness of and motivation to work with interpersonal issues may be essential for compliance with group therapy.
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Affiliation(s)
- Hans Henrik Jensen
- Hans Henrik Jensen, Mag. Art., Associate professor, Department of Environmental Health, Institute of Public Health, University of Copenhagen , Denmark
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[Dropout behavior during inpatient psychotherapy ]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2014; 60:238-50. [PMID: 25331921 DOI: 10.13109/zptm.2014.60.3.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Dropouts result in far-reaching consequences for the individual patient, fellow patients, therapists, and the clinic. This study was aimed at early identification of patients with a dropout risk. METHODS Data from patients of the Department of Psychosomatic Medicine and Psychotherapy of the Medical University Clinic of Tübingen (Germany) were analyzed retrospectively in a case-control study (matched). Differences in the results of various questionnaires (SCL-90-R, IIP-D, SF-36) regarding reasons for dropout and sociodemographic data were analyzed. A total of 59 dropouts, 50 females and 9 males, were included. They were split into 28 early dropouts and 31 late dropouts. The data were compared between early and late dropouts and control group. RESULTS Early dropouts were significantly younger than late dropouts; they tended to live with their parents or on their own, and suffered more frequently from eating disorders. Late dropouts lived together with partners and suffered from somatoform disorders more frequently than early dropouts. The reasons given for dropout did not differ between the groups. No differences between dropouts and the controls were found with respect to psychopathology (SCL- 90-R) and quality of life (SF-36). Late dropouts did show significantly lower scores on the scale "autocracy/dominance" than the controls (IIP). CONCLUSIONS Therapy dropout is a multifactorial occurrence. It is generally not predictable, though it may be predicted with different instruments on the basis of a diagnosis, especially with respect to interpersonal behavior patterns. In further studies, targeted interventions should be developed and tested which enable procedures to minimize the risk of dropout and to achieve complete treatment according to patients' intentions.
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Fenger M, Mortensen EL, Poulsen S, Lau M. A register-based study of long-term healthcare use before and after psychotherapy. Nord J Psychiatry 2014; 68:450-9. [PMID: 24274838 DOI: 10.3109/08039488.2013.855255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Psychotherapeutic treatment for non-psychotic disorders is associated with significant reduction in patients' symptoms, and therefore it is believed that treatment improves health and decreases the need for additional healthcare. However, little is known about long-term changes in utilization of healthcare services. AIM To investigate long-term changes in utilization of public healthcare services for patients referred to psychotherapeutic treatment. METHODS A pre-post study with 761 consecutive patients and 15,220 matched individuals in a matched population reference group. Data from a comprehensive set of healthcare services were collected from central registries for 4 years prior to intake and for 4 years after completion of treatment. RESULTS Of the 761 patients, 216 did not show up for treatment and 545 completed treatment. Completer patients achieved a substantial reduction in symptoms (effect size, ES = 0.99). However, completer patients increased their use of all healthcare services by 296% (ES = 0.58) in the 4th year pre-post comparison, while the reference group increased usage by 99% (ES = 0.23). Completer patients had significantly higher increase in contacts with psychiatric hospitals (P < 0.008), contacts with primary care psychologists (P < 0.001), psychotropic medication (P < 0.001) and contacts with primary care physicians (P < 0.001) than the reference group at the 4th year pre-post comparison. CONCLUSION Over a long-term period, patients who completed psychotherapeutic treatment increased utilization of healthcare services. Studies are needed to clarify how and why psychotherapeutic treatment does not necessarily lead to a reduction in the utilization of healthcare services for the average patient and to evaluate other potential interventions for patients with mental problems and include efficiency studies in this evaluation.
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Affiliation(s)
- Morten Fenger
- Morten Fenger, Ph.D., M.S.Psych., Stolpegaard Psychotherapy Centre, Mental Health Services , Capital Region of Denmark
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Anestis JC, Gottfried ED, Joiner TE. The Utility of MMPI-2-RF Substantive Scales in Prediction of Negative Treatment Outcomes in a Community Mental Health Center. Assessment 2014; 22:23-35. [DOI: 10.1177/1073191114536771] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the utility of the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) substantive scales in the prediction of premature termination and therapy no-shows while controlling for other relevant predictors in a university-based community mental health center, a sample at high risk of both premature termination and no-show appointments. Participants included 457 individuals seeking services from a university-based psychology clinic. Results indicated that Juvenile Conduct Problems (JCP) predicted premature termination and Behavioral/Externalizing Dysfunction and JCP predicted number of no-shows, when accounting for initial severity of illness, personality disorder diagnosis, therapist experience, and other related MMPI-2-RF scales. The MMPI-2-RF Aesthetic-Literary Interests scale also predicted number of no-shows. Recommendations for applying these findings in clinical practice are discussed.
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Bassilios B, Nicholas A, Reifels L, Pirkis J. Uptake of a national primary mental health program by young people in Australia. Int J Ment Health Syst 2014; 8:10. [PMID: 24655557 PMCID: PMC3994453 DOI: 10.1186/1752-4458-8-10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 03/17/2014] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to examine the uptake of an Australian primary mental health care program (Access to Allied Psychological Services) by young people aged 12 to 25 years and the characteristics of consumers and the treatments received. Data were sourced from a national web-based minimum dataset. Results Between 1 July 2003 and 30 June 2012, 51 716 young consumers received 245 704 sessions via the primary mental health program. Around two thirds were female and the average age was 19 years. The majority had depressive and/or anxiety disorders. Most services were delivered to individuals (including just the young person and/or the young person with one or both parents), in a face-to-face context and free of charge. Cognitive and behavioral strategies were the most common interventions delivered. Conclusions The primary mental health care program has been well utilized by people aged 12 to 25 years. Similar programs in other developed countries may improve access to primary mental health care for young people.
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Affiliation(s)
- Bridget Bassilios
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria 3010, Australia.
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Schauman O, Mansell W. Processes underlying ambivalence in help‐seeking: The loss of valued control model. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2012. [DOI: 10.1111/j.1468-2850.2012.01277.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wozenilek AC, Pomerantz AM, Pettibone JC, Segrist DJ. When Clients No-Show: An Empirical Analogue Study of Psychologists’ Response Strategies. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2011. [DOI: 10.1007/s10879-011-9196-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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