Drop-out and ineffective treatment in youth with severe and enduring mental health problems: a systematic review

Abstract

Youth with severe and enduring mental health problems (SEMHP) tend to drop out of treatment or insufficiently profit from treatment in child and adolescent psychiatry (CAP). Knowledge about factors related to treatment failure in this group is scarce. Therefore, the aim of this systematic review was to thematically explore factors associated with dropout and ineffective treatment among youth with SEMHP. After including 36 studies, a descriptive thematic analysis was conducted. Themes were divided into three main categories: client, treatment, and organizational factors. The strongest evidence was found for the association between treatment failure and the following subthemes: type of treatment, engagement, transparency and communication, goodness of fit and, perspective of practitioner. However, most other themes showed limited evidence and little research has been done on organizational factors. To prevent treatment failure, attention should be paid to a good match between youth and both the treatment and the practitioner. Practitioners need to be aware of their own perceptions of youth’s perspectives, and transparent communication with youth contributes to regaining their trust.

Towards identifying the characteristics of youth with severe and enduring mental health problems in practice: a qualitative study

“…Moreover, both this study and previous research found that youth with SEMHP regularly drop out of school and show problems in peer relationships and family life [ 2 , 4 , 39 ]. Our study exposed potential reasons why these problems arise, such as the lack of social support by peers and family members.…”

Congruency of multimodal data-driven personalization with shared decision-making for StayFine: individualized app-based relapse prevention for anxiety and depression in young people

“…The Dutch version has good internal consistency (αNA = 0.83, αPA = 0.79; 66). In the current study, cutoff values to determine suboptimal affect were scores lower than 30 for the PA subscale and higher than 30 for the NA subscale, based on averaging the minimum (10) and maximum (49) scores per subscale.…”

“…Possibly because standardized EBTs, as opposed to personspecific approaches, assume interventions can target homogenous clinical symptom profiles between individuals (9). Concerning effectiveness and efficiency, practitioners have mentioned that standardized EBTs have difficulty handling more complex cases, leave little room to individualize in their strict and uniform structure, and hamper spontaneity and flexibility during treatment (10). This can lead to dropout in youth with more severe and enduring mental health problems through demotivation or iatrogenic harm, which may create pessimism for and in future treatment (11).…”