Predictors of Attrition During One Year of Depression Treatment: A Roadmap to Personalized Intervention

Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA.
Journal of psychiatric practice 04/2009; 15(2):113-24. DOI: 10.1097/01.pra.0000348364.88676.83
Source: PubMed


Attrition from treatment in the short and long term for major depressive disorder (MDD) is clearly an adverse outcome. To assist in tailoring the delivery of interventions to specific patients to reduce attrition, this study reports the incidence, timing, and predictors of attrition from outpatient treatment in public mental health clinics.
Outpatients with psychotic and nonpsychotic MDD receiving measurement-based care in the Texas Medication Algorithm Project (N=179) were evaluated to determine timing and rates of attrition as well as baseline sociodemographic, clinical, and attitudinal predictors of attrition.
Overall, 23% (42/179) of the patients left treatment by 6 months, and 47% (84/179) left by 12 months. Specific beliefs about the impact of medication, such as its perceived harmfulness, predicted attrition at both 6 and 12 months. Younger age (P=0.0004) and fewer side effects at baseline (P=0.0376) were associated with attrition at 6 months. Younger age (P=0.0013), better perceived physical functioning (P=0.0007), and more negative attitudes about psychiatric medications at baseline (P=0.0075) were associated with attrition at 12 months.
Efforts to elicit attitudes about medications and tailoring educational and other retention interventions for patients with negative beliefs about antidepressants both when initiating a new medication and throughout treatment may reduce attrition. Particular focus on younger patients and those requiring frequent visits may be helpful.

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Available from: Augustus John Rush, Aug 11, 2014
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    • "Patient adherence behaviors also interfere with the delivery of adequate depression treatment. Patient-level predictors associated with lower adherence to antidepressant medication include younger age (Edlund et al., 2002), fewer years of education (Olfson, Marcus, Tedeschi, & Wan, 2006), minority status (Arnow et al., 2007; Olfson et al., 2006; Warden et al., 2007), better perceived physical functioning (Warden et al., 2009), and type of medication (Machado, Iskedjian , Ruiz, & Einarson, 2006; Tai-Seale, Croghan, & Obenchain, 2000). Lower adherence to psychotherapy is associated with all but the final two of the above patient-level factors (Arnow et al., 2007; Edlund et al., 2002), and is further affected by referral source (Hampton-Robb, Qualls, & Compton, 2003), poorer therapeutic alliance (Arnow et al., 2007), and perceived practical barriers to treatment (e.g. "

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    • "Psychological factors, including negative beliefs about perceived harmful effects, stigma, and lack of "buy in" of the treatment rationale, are negatively related to adherence and outcome (e.g., Aikens, Nease, Nau, Klinkman, & Schwenk, 2005; Warden et al., 2009). These issues can be addressed through careful psychoeducation and monitoring. "
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