Treatment dropout among veterans and their families: Quantitative and qualitative findings.
Treatment dropout among veterans and their families: Quantitative and qualitative findings.
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DOI：
10.1037/tra0001109
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发表时间：
2022-05
期刊：
影响因子：
--
通讯作者：
Neria Y
中科院分区：
文献类型：
--
作者：
Amsalem D;Lopez-Yianilos A;Lowell A;Pickover AM;Arnon S;Zhu X;Suarez-Jimenez B;Ryba M;Bergman M;Such S;Zalman H;Sanchez-Lacay A;Lazarov A;Markowitz JC;Neria Y
退伍军人及其家人的心理治疗未完成率很高。这项研究试图1)测量这类患者在大学治疗中心的未完成率，2)比较退伍军人和家庭成员的流失率，3)确定辍学预测因素，4)探索临床医生对治疗未完成的看法。我们采用定量和定性相结合的方法，分析了某大学治疗中心141名患者(90名退伍军人；51名家属)的人口学和临床特征。我们将辍学定义为没有完成限时治疗合同。回顾评估临床医生对患者退出的看法的半结构化访谈数据，三名独立评分者在关键主题上达成一致，评价者间系数kappa在0.74至1之间。患者流失率为24%，退伍军人和家庭成员之间没有显著差异。重度抑郁症(MDD)的诊断和基于暴露的治疗预示着未完成治疗，以及较高的基线汉密尔顿抑郁评定量表(HDRS)总分、严重抑郁症(HDRS>；20)、缺乏贝克抑郁问卷每周改善，以及军人性创伤病史。临床医生大多将未完成归因于患者难以应对强烈的情绪，特别是在基于暴露的治疗中。与其他以退伍军人为基础的治疗中心相比，这项研究的未完成率似乎相对较低，尽管遗憾的是仍然很高。MDD/PTSD和基于暴露的治疗并存的患者由于MDD的成分而具有更大的未完成风险，这应该在治疗计划中考虑到。在一个强大的治疗联盟的背景下，正在进行的关于不满意和患者停止治疗的讨论可能会减少这一高危人群中的未完成治疗。
Psychotherapy non-completion rates for veterans and their families are high. This study sought to 1) measure non-completion rates of such patients at a university-based treatment center, 2) compare veteran and family member attrition rates, 3) identify dropout predictors, and 4) explore clinicians’ perspectives on treatment non-completion. Using quantitative and qualitative approaches, we analyzed demographic and clinical characteristics of 141 patients (90 military veterans; 51 family members) in a university treatment center. We defined dropout as not completing the time-limited therapy contract. Reviewing semi-structured interview data assessing clinicians’ perspectives on their patients’ dropout, three independent raters agreed on key themes, with interrater coefficient kappa range 0.74 to 1. Patient attrition was 24%, not differing significantly between veterans and family members. Diagnosis of major depression (MDD) and exposure-based therapies predicted non-completion, as did higher baseline Hamilton Depression Rating Scale (HDRS) total scores, severe depression (HDRS>20), lack of Beck Depression Inventory weekly improvement, and history of military sexual trauma. Clinicians mostly attributed non-completion to patient difficulties coping with intense emotions, especially in exposure-based therapies. Non-completion rate at this study appeared relatively low compared to other veteran-based treatment centers, if still unfortunately substantial. Patients with comorbid MDD/PTSD and exposure-based therapies carried greater non-completion risk due to the MDD component, and this should be considered in treatment planning. Ongoing discussion of dissatisfaction and patient discontinuation, in the context of a strong therapeutic alliance, might reduce non-completion in this at-risk population.
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