Client predictors of therapy dropout in a primary care setting: a prospective cohort study

doi:10.1186/s12888-023-04878-7

Randomized Controlled Trial

. 2023 May 24;23(1):358.

doi: 10.1186/s12888-023-04878-7.

Client predictors of therapy dropout in a primary care setting: a prospective cohort study

Elin Hanevik^#¹, Frida M G Røvik^#², Tormod Bøe^{3

4}, Marit Knapstad⁵, Otto R F Smith^{6

7

8}

Affiliations

¹ Søndre Oslo DPS, Helga Vaneks Vei 6, 1281, Oslo, Norway.
² Rask Psykisk Helsehjelp, Bydel Ullern, Hoffsveien 48, 0377, Oslo, Norway.
³ Department of Psychosocial Science, The University of Bergen, Christies Gate 12, 5015, Bergen, Norway.
⁴ RKBU Vest, NORCE Norwegian Research Centre, Bergen, Norway.
⁵ Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway.
⁶ Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway. robert.smith@fhi.no.
⁷ Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway. robert.smith@fhi.no.
⁸ Department of Teacher Education, NLA University College, Pb 74 Sandviken, 5812, Bergen, Norway. robert.smith@fhi.no.

^# Contributed equally.

PMID: 37226210
PMCID: PMC10207790
DOI: 10.1186/s12888-023-04878-7

Randomized Controlled Trial

Client predictors of therapy dropout in a primary care setting: a prospective cohort study

Elin Hanevik et al. BMC Psychiatry. 2023.

. 2023 May 24;23(1):358.

doi: 10.1186/s12888-023-04878-7.

Authors

Elin Hanevik^#¹, Frida M G Røvik^#², Tormod Bøe^{3

4}, Marit Knapstad⁵, Otto R F Smith^{6

7

8}

Affiliations

¹ Søndre Oslo DPS, Helga Vaneks Vei 6, 1281, Oslo, Norway.
² Rask Psykisk Helsehjelp, Bydel Ullern, Hoffsveien 48, 0377, Oslo, Norway.
³ Department of Psychosocial Science, The University of Bergen, Christies Gate 12, 5015, Bergen, Norway.
⁴ RKBU Vest, NORCE Norwegian Research Centre, Bergen, Norway.
⁵ Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway.
⁶ Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gate 7, 5015, Bergen, Norway. robert.smith@fhi.no.
⁷ Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway. robert.smith@fhi.no.
⁸ Department of Teacher Education, NLA University College, Pb 74 Sandviken, 5812, Bergen, Norway. robert.smith@fhi.no.

^# Contributed equally.

PMID: 37226210
PMCID: PMC10207790
DOI: 10.1186/s12888-023-04878-7

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.

Trial registration: ClinicalTrials.gov NCT03238872.

Keywords: Cognitive Behavioral Therapy; Dropout; Improving Access to Psychological Therapies; Prompt Mental Health Care.

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Conflict of interest statement

The authors declare that they have no competing interests.

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References

1. Barrett MS, Chua WJ, Crits-Christoph P, Gibbons MB, Thompson D. Early withdrawal from mental health treatment: Implications for psychotherapy practice. Psychotherapy. 2008;45(2):247–267. doi: 10.1037/a0016184. - DOI - PMC - PubMed
1. Beck NC, Lamberti J, Gamache M, Lake EA, Fraps CL, McReynolds WT, et al. Situational factors and behavioral self-predictions in the identification of clients at high risk to drop out of psychotherapy. J Clin Psychol. 1987;43(5):511–520. doi: 10.1002/1097-4679(198709)43:5<511::AID-JCLP2270430515>3.0.CO;2-U. - DOI - PubMed
1. Binnie J, Boden Z. Non-attendance at psychological therapy appointments. Ment Health Rev J. 2016;21(3):231–248. doi: 10.1108/MHRJ-12-2015-0038. - DOI
1. Cahill J, Barkham M, Hardy G, Rees A, Shapiro DA, Stiles WB, et al. Outcomes of patients completing and not completing cognitive therapy for depression. Br J Clin Psychol. 2003;42(2):133–143. doi: 10.1348/014466503321903553. - DOI - PubMed
1. Clark DM. Realizing the mass public benefit of evidence-based psychological therapies: The IAPT program. Annu Rev Clin Psychol. 2018;14(1):159–183. doi: 10.1146/annurev-clinpsy-050817-084833. - DOI - PMC - PubMed

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[1] Barrett MS, Chua WJ, Crits-Christoph P, Gibbons MB, Thompson D. Early withdrawal from mental health treatment: Implications for psychotherapy practice. Psychotherapy. 2008;45(2):247–267. doi: 10.1037/a0016184. - DOI - PMC - PubMed

[2] Barrett MS, Chua WJ, Crits-Christoph P, Gibbons MB, Thompson D. Early withdrawal from mental health treatment: Implications for psychotherapy practice. Psychotherapy. 2008;45(2):247–267. doi: 10.1037/a0016184. - DOI - PMC - PubMed

[3] Beck NC, Lamberti J, Gamache M, Lake EA, Fraps CL, McReynolds WT, et al. Situational factors and behavioral self-predictions in the identification of clients at high risk to drop out of psychotherapy. J Clin Psychol. 1987;43(5):511–520. doi: 10.1002/1097-4679(198709)43:5<511::AID-JCLP2270430515>3.0.CO;2-U. - DOI - PubMed

[4] Beck NC, Lamberti J, Gamache M, Lake EA, Fraps CL, McReynolds WT, et al. Situational factors and behavioral self-predictions in the identification of clients at high risk to drop out of psychotherapy. J Clin Psychol. 1987;43(5):511–520. doi: 10.1002/1097-4679(198709)43:5<511::AID-JCLP2270430515>3.0.CO;2-U. - DOI - PubMed

[5] Binnie J, Boden Z. Non-attendance at psychological therapy appointments. Ment Health Rev J. 2016;21(3):231–248. doi: 10.1108/MHRJ-12-2015-0038. - DOI

[6] Binnie J, Boden Z. Non-attendance at psychological therapy appointments. Ment Health Rev J. 2016;21(3):231–248. doi: 10.1108/MHRJ-12-2015-0038. - DOI

[7] Cahill J, Barkham M, Hardy G, Rees A, Shapiro DA, Stiles WB, et al. Outcomes of patients completing and not completing cognitive therapy for depression. Br J Clin Psychol. 2003;42(2):133–143. doi: 10.1348/014466503321903553. - DOI - PubMed

[8] Cahill J, Barkham M, Hardy G, Rees A, Shapiro DA, Stiles WB, et al. Outcomes of patients completing and not completing cognitive therapy for depression. Br J Clin Psychol. 2003;42(2):133–143. doi: 10.1348/014466503321903553. - DOI - PubMed

[9] Clark DM. Realizing the mass public benefit of evidence-based psychological therapies: The IAPT program. Annu Rev Clin Psychol. 2018;14(1):159–183. doi: 10.1146/annurev-clinpsy-050817-084833. - DOI - PMC - PubMed

[10] Clark DM. Realizing the mass public benefit of evidence-based psychological therapies: The IAPT program. Annu Rev Clin Psychol. 2018;14(1):159–183. doi: 10.1146/annurev-clinpsy-050817-084833. - DOI - PMC - PubMed

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Client predictors of therapy dropout in a primary care setting: a prospective cohort study

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Client predictors of therapy dropout in a primary care setting: a prospective cohort study

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