Reducing Dropout in Treatment for Depression: Translating Dropout Predictors Into Individualized Treatment Recommendations. 2016

Sigal Zilcha-Mano, and John R Keefe, and Harold Chui, and Avinadav Rubin, and Marna S Barrett, and Jacques P Barber
Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel. sigalzil@gmail.com.

OBJECTIVE Premature discontinuation of therapy is a widespread problem that hampers the delivery of mental health treatment. A high degree of variability has been found among rates of premature treatment discontinuation, suggesting that rates may differ depending on potential moderators. In the current study, our aim was to identify demographic and interpersonal variables that moderate the association between treatment assignment and dropout. METHODS Data from a randomized controlled trial conducted from November 2001 through June 2007 (N = 156) comparing supportive-expressive therapy, antidepressant medication, and placebo for the treatment of depression (based on DSM-IV criteria) were used. Twenty prerandomization variables were chosen based on previous literature. These variables were subjected to exploratory bootstrapped variable selection and included in the logistic regression models if they passed variable selection. RESULTS Three variables were found to moderate the association between treatment assignment and dropout: age, pretreatment therapeutic alliance expectations, and the presence of vindictive tendencies in interpersonal relationships. When patients were divided into those randomly assigned to their optimal treatment and those assigned to their least optimal treatment, dropout rates in the optimal treatment group (24.4%) were significantly lower than those in the least optimal treatment group (47.4%; P = .03). CONCLUSIONS Present findings suggest that a patient's age and pretreatment interpersonal characteristics predict the association between common depression treatments and dropout rate. If validated by further studies, these characteristics can assist in reducing dropout through targeted treatment assignment. BACKGROUND Secondary analysis of data from ClinicalTrials.gov identifier: NCT00043550.

UI MeSH Term Description Entries
D007398 Interpersonal Relations The reciprocal interaction of two or more persons. Social Relationships,Husband-Wife Communication,Partner Communication,Communication, Husband-Wife,Communication, Partner,Husband Wife Communication,Husband-Wife Communications,Interpersonal Relation,Partner Communications,Relation, Interpersonal,Relationship, Social,Social Relationship
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010043 Outcome and Process Assessment, Health Care Evaluation procedures that focus on both the outcome or status (OUTCOMES ASSESSMENT) of the patient at the end of an episode of care - presence of symptoms, level of activity, and mortality; and the process (ASSESSMENT, PROCESS) - what is done for the patient diagnostically and therapeutically. Outcome and Process Assessment (Health Care),Donabedian Model,Donabedian Triad,Outcome and Process Assessment,Structure Process Outcome Triad,Model, Donabedian,Triad, Donabedian
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
D010554 Personality Disorders A major deviation from normal patterns of behavior. Avoidant Personality Disorder,Impulse-Ridden Personality,Inadequate Personality,Avoidant Personality Disorders,Impulse Ridden Personality,Personality Disorder,Personality Disorder, Avoidant,Personality Disorders, Avoidant,Personality, Impulse-Ridden,Personality, Inadequate
D011613 Psychotherapy A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. Psychotherapies
D003866 Depressive Disorder An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. Depression, Endogenous,Depression, Neurotic,Depression, Unipolar,Depressive Syndrome,Melancholia,Neurosis, Depressive,Unipolar Depression,Depressions, Endogenous,Depressions, Neurotic,Depressions, Unipolar,Depressive Disorders,Depressive Neuroses,Depressive Neurosis,Depressive Syndromes,Disorder, Depressive,Disorders, Depressive,Endogenous Depression,Endogenous Depressions,Melancholias,Neuroses, Depressive,Neurotic Depression,Neurotic Depressions,Syndrome, Depressive,Syndromes, Depressive,Unipolar Depressions
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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