Journal
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
Volume 87, Issue 8, Pages 745-755Publisher
AMER PSYCHOLOGICAL ASSOC
DOI: 10.1037/ccp0000414
Keywords
attendance; attrition; community mental health; depression; dropout
Categories
Funding
- Agency for Healthcare Research and Quality [R01HS018440, K02HS022124]
- National Institute of Mental Health Award [R01MH092363]
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Objective: Our goal was to evaluate treatment attendance patterns, including both treatment completion and premature termination from treatment, for 2 evidence-based psychotherapies for major depressive disorder (MDD) delivered in a community mental health setting. We explored rates of premature termination across the course of treatment as well as the factors that predicted and moderated premature termination and treatment completion. Method: This investigation included 237 patients with MDD who participated in a noninferiority trial comparing short-term dynamic psychotherapy (DT) to cognitive therapy (CT). Patients in both conditions were offered 16 sessions of treatment and had up to 5 months to complete treatment. All patients completed an extensive self-report battery at treatment baseline as well as measures of the therapeutic alliance and opinions about treatment following Session 2. Results: Premature termination from both treatments was high with 27% of patients discontinuing treatment very early after only an intake session or a single treatment session. Patients in CT were significantly more likely to terminate treatment prematurely, chi(2)(3) = 14.35, p=.002. Baseline physical health functioning, subthreshold psychotic symptoms, Session 2 ratings of agreement on tasks, and Session 2 ratings of treatment sensibility all independently predicted premature termination of services. Trauma history significantly moderated very early termination of treatment, chi(2)(3) = 10.26, p = .017, with patients with high trauma histories more likely to complete DT but terminate prematurely from CT. Conclusions: Very early termination from services was higher in CT compared with DT. Including techniques to improve engagement in both therapies and matching patients to treatment based on predictors/moderators may be effective ways to optimize treatment engagement.
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