Early Dropout from Psychotherapy for Depression with Group- and Network-model Therapists

Abstract

Administrative data were used to examine early dropout among 16,451 health plan members calling to request psychotherapy for depression. Compared to members referred to group-model therapists, those referred to network-model therapists were more likely to drop out before the initial visit (OR 2.33, 95% CI 2.17 – 2.50) but less likely to drop out after the first visit (OR 0.45, 95% CI 0.43 – 0.48). These differences were unaffected by adjustment for neighborhood income and educational attainment, antidepressant use, or generosity of insurance coverage. Efforts to increase the effectiveness of psychotherapy may required different strategies in group- and network-model practice.

Is treatment adherence consistent across time, across different treatments and across diagnoses?

“…These data were collected for a larger study examining predictors of adherence to psychotherapy for depression (7). The study population included all members aged 13 and older requesting an initial psychotherapy visit for a chief complaint of depression between 1/1/2003 and 12/31/2008.…”

“…Among outpatients starting antidepressant treatment for depression, fewer than half continue medication through 12 weeks of acute-phase treatment (4–6). Among outpatients making an initial psychotherapy visit for depression, one third do not return for a second visit and fewer than half continue for four or more visits (7, 8). Increasing adherence to treatment is a central component of most successful depression care improvement programs (9–11).…”

“…Previous research has identified predictors of adherence to antidepressants, including higher income or educational attainment, white race, non-Hispanic ethnicity, lower out-of-pocket costs, and history of previous antidepressant treatment (4, 14, 15). Regarding adherence to psychotherapy for depression, previous research typically finds higher rates of treatment continuation associated with older age, greater educational attainment, history of previous psychotherapy, and lower out-of-pocket costs (7, 16–20). Previous research consistently finds that depression is associated with poorer adherence to concomitant treatments for chronic medical conditions (21, 22).…”

Health reform and the Affordable Care Act: The importance of mental health treatment to achieving the triple aim

“…Primary care providers in the United States are more than twice as likely to report problems with referral of patients with mental health problems to specialists than any other chronic condition [25]. Moreover, a large US study showed that only approximately 60% of patients referred by primary care doctors to mental health specialists actually followed through with the referral [26], and studies have shown that the mean number of appointments in those who do pursue a specialty mental health referral is two [27]. Thus, few patients who receive mental health care after primary care referral actually receive an adequate “dose” of mental health care.…”

“…As few as 20% of patients started on antidepressant medications in “usual” primary care show substantial clinical improvement [34,35]. Many patients referred to psychotherapy receive an insufficient number of visits and/or ineffective forms of psychotherapy [27,36], so that treatment response for this type of treatment is also as low as 20% [34,36]. Finally, poor quality of medical care in patients with mental illness may explain a significant portion of their excess mortality [37].…”