Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials
Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials
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DOI：
10.1016/j.cpr.2015.05.001
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发表时间：
2015-08-01
影响因子：
12.8
通讯作者：
Conklin, Laren R.
中科院分区：
文献类型：
--
作者：
Cooper, Andrew A.;Conklin, Laren R.
退出心理健康治疗是一个严重的问题，但在不同的研究和诊断中，这一比例差异很大。需要进行重点审查，以便为具体的研究领域提供更详细的估计。涉及单极抑郁症个体心理治疗的随机临床试验是普遍和重要的，但缺乏这些研究的平均辍学率的经验数据。我们对54项这样的研究（N = 5852）进行了随机效应荟萃分析，包括80种心理治疗条件，并评估了一些治疗和研究水平辍学率的预测因素。在研究水平上，我们的总体加权退学估计为19.9%，特别是心理治疗条件下的退学估计为17.5%。治疗取向并没有显著地解释辍学估计值的差异，但在治疗条件下，少数种族身份的患者或合并人格障碍的患者的估计值明显更高。在趋势水平上，治疗时间也与辍学率呈正相关。不活跃对照的研究比没有这种情况的研究有更高的辍学率。局限性包括由于报告不频繁而无法测试某些潜在的预测因素（例如，社会经济地位）。总的来说，我们的研究结果表明，需要考虑具体的患者和研究特征如何影响抑郁症个体化治疗的临床研究中的辍学率。(C) 2015 Elsevier Ltd.版权所有。
Dropout from mental health treatment poses a substantial problem, but rates vary substantially across studies and diagnoses. Focused reviews are needed to provide more detailed estimates for specific areas of research. Randomized clinical trials involving individual psychotherapy for unipolar depression are ubiquitous and important, but empirical data on average dropout rates from these studies is lacking. We conducted a random-effects meta-analysis of 54 such studies (N = 5852) including 80 psychotherapy conditions, and evaluated a number of predictors of treatment- and study-level dropout rates. Our overall weighted dropout estimates were 19.9% at the study level, and 17.5% for psychotherapy conditions specifically. Therapy orientation did not significantly account for variance in dropout estimates, but estimates were significantly higher in psychotherapy conditions with more patients of minority racial status or with comorbid personality disorders. Treatment duration was also positively associated with dropout rates at trend level. Studies with an inactive control comparison had higher dropout rates than those without such a condition. Limitations include the inability to test certain potential predictors (e.g., socioeconomic status) due to infrequent reporting. Overall, our findings suggest the need to consider how specific patient and study characteristics may influence dropout rates in clinical research on individual therapy for depression. (C) 2015 Elsevier Ltd. All rights reserved.