Predictors of early dropout from psychotherapy for depression in community practice. 2010

Gregory E Simon, and Evette J Ludman
Group Health Research Institute, 1730 Minor Ave., Seattle, WA 98101-1448, USA. simon.g@ghc.org

OBJECTIVE Data from a managed care health system were used to examine demographic, clinical, and health system predictors of early dropout from psychotherapy for depression. METHODS A total of 238 members of a mixed-model health plan calling to request an initial psychotherapy visit for depression completed a brief survey regarding depression severity, perceived need for treatment, and expected benefit. Claims records were used to assess therapy visits attended over the following 90 days. RESULTS Dropout rates before the first therapy visit were somewhat higher among women (p=.041) and younger members (p=.017), moderately higher among those with lower depression severity (p=.012), and markedly higher among callers referred to network-model psychotherapists (compared with those given appointments with group-model therapists at health plan clinics) (p<.001). By the second visit, however, cumulative dropout rates were similar for group- and network-model therapists. The only significant predictors of cumulative dropout rates before the second visit were less severe depression at the screening call (p=.004) and lower self-rated importance of initiating psychotherapy (p=.046). CONCLUSIONS Early dropout from psychotherapy for depression was only weakly related to consumers' demographic characteristics. Dropout rates were lower among those with more severe depression, but a significant number of persons with moderate or severe symptoms of depression still discontinued treatment before the second visit. Allocation of visits for individual consumers was markedly different for group- and network-model psychotherapists, but these data did not allow for examination of differences in outcomes for those two treatment models.

UI MeSH Term Description Entries
D007061 Idaho State bounded on the north by Canada, on the east by Montana and Wyoming, on the south by Nevada and Utah, and on the west by Oregon and Washington.
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010352 Patient Dropouts Discontinuance of care received by patient(s) due to reasons other than full recovery from the disease. Dropout, Patient,Dropouts, Patient,Patient Dropout
D011613 Psychotherapy A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. Psychotherapies
D003156 Community Mental Health Services Diagnostic, therapeutic and preventive mental health services provided for individuals in the community. Community Mental Health Service,Mental Health Services, Community,Assertive Community Treatment,Health Services, Community Mental,Services, Community Mental Health,Services, Mental Health Community,Community Treatment, Assertive,Treatment, Assertive Community
D003863 Depression Depressive states usually of moderate intensity in contrast with MAJOR DEPRESSIVE DISORDER present in neurotic and psychotic disorders. Depressive Symptoms,Emotional Depression,Depression, Emotional,Depressive Symptom,Symptom, Depressive
D005260 Female Females
D005544 Forecasting The prediction or projection of the nature of future problems or existing conditions based upon the extrapolation or interpretation of existing scientific data or by the application of scientific methodology. Futurology,Projections and Predictions,Future,Predictions and Projections
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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