Dropout revisited: patient- and therapist-initiated discontinuation of psychotherapy as a function of organizational instability. 2014

Andrzej Werbart, and Håkan Andersson, and Rolf Sandell
a Department of Psychology, Stockholm University , Stockholm, Sweden.

OBJECTIVE To explore the association between the stability or instability of services' organizational structure and patient- and therapist-initiated discontinuation of therapy in routine mental health. METHODS Three groups, comprising altogether 750 cases in routine mental health care in eight different clinics, were included: cases with patient-initiated discontinuation, therapist-initiated discontinuation, and patients remaining in treatment. Multilevel multinomial regression was used to estimate three models: An initial, unconditional intercept-only model, another one including patient variables, and a final model with significant patient and therapist variables including the organizational stability of the therapists' clinic. RESULTS High between-therapist variability was noted. Odds ratios and significance tests indicated a strong association of organizational instability with patient-initiated premature termination in particular. CONCLUSIONS The question of how organizational factors influence the treatment results needs further research. Future studies have to be designed in ways that permit clinically meaningful subdivision of the patients' and the therapists' decisions for premature termination.

UI MeSH Term Description Entries
D008297 Male Males
D008605 Mental Health Services Organized services to provide mental health care. Mental Hygiene Services,Health Services, Mental,Services, Mental Health,Services, Mental Hygiene,Health Service, Mental,Hygiene Service, Mental,Hygiene Services, Mental,Mental Health Service,Mental Hygiene Service,Service, Mental Health,Service, Mental Hygiene
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
D011369 Professional-Patient Relations Interactions between health personnel and patients. Contacting Clients,Pharmacist-Patient Relations,Professional Patient Relationship,Client, Contacting,Clients, Contacting,Contacting Client,Pharmacist Patient Relations,Pharmacist-Patient Relation,Professional Patient Relations,Professional Patient Relationships,Professional-Patient Relation,Relation, Pharmacist-Patient,Relation, Professional-Patient,Relations, Pharmacist-Patient,Relations, Professional-Patient,Relationship, Professional Patient,Relationships, Professional Patient
D011613 Psychotherapy A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. Psychotherapies
D005260 Female Females
D006302 Health Services Research The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed) Health Care Research,Medical Care Research,Research, Health Services,Action Research,Health Services Evaluation,Healthcare Research,Research, Medical Care,Evaluation, Health Services,Evaluations, Health Services,Health Services Evaluations,Research, Action,Research, Health Care,Research, Healthcare
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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