Determinants of dropout in a community-based mental health crisis centre

Abstract

BackgroundDropping out during the course of medical follow up is defined as an early therapy withdrawal without the agreement of the therapist. In a psychiatric crisis unit in Geneva, we empirically observed that almost 50 % of the patients were not showing up to their first appointments, which were scheduled for 3 to 7 days post discharge.MethodsThe aim of this naturalistic descriptive cohort study is to identify the demographic, patient and care-related predictive factors of dropout in a community-based psychiatric crisis centre. We included 245 consecutive outpatients followed-up for 4 to 6 weeks of intensive outpatient psychiatric treatment. Logistic regression models were built to examine the association between dropout and demographic, care and patient-related variables.ResultsAmong the 245 outpatients, dropout occurred in 37.5 % of cases, and it most frequently occurred (81.8 %) in the first 2 days of follow-up. Among care-related variables, referral by hospital units or private psychiatrists led to significantly lower levels of dropout compared to patients referred by the psychiatric emergency unit (respectively: OR = .32; p = .04; 95 % CI [.10, .93]; OR = .36; p = .04; 95 % CI [.13, .96]; OR = .22; p = .002; 95 % CI [.08, .58]). Among patient-related variables, younger age increased the risk of dropout (OR = .96; 95 %; p = .002; 95 % CI [.94, .99]). Anxiety and personality but not mood disorders were also related to higher rates of dropout (respectively: OR = 2.40; p = .02; 95 % CI [1.14, 4.99]; and OR = 1.98; p = .02; 95 % CI [1.09, 3.59]). Unipolar depression (72.2 %; OR = 1.47; p = .48; 95 % CI [.34, 1.21]) was the most frequent primary diagnosis in this sample.ConclusionsThis study makes clear the need for increased efforts to improve care adherence in young patients with anxious or personality disorders seen in emergency rooms because they are prone to early discontinuation of treatments. Future studies in this field are warranted to gain a better understanding into the complex reasons that surround discontinuation of care in outpatient settings.

Emotional crisis in a naturalistic context: characterizing outpatient profiles and treatment effectiveness

“…Most of the patients were diagnosed as presenting a depressive or neurotic disorder with low global functioning and were administered a polypharmacological treatment. Regarding socio-demographic variables and crisis features, our findings are consistent with those reported in previous studies conducted in very similar psychiatric services providing crisis treatment [9,14,15,17,[50][51][52][53]. Nevertheless, we found a higher percentage of working patients and student patients than in other studies [22] as well as patients on average 10 years older than those from Marini's study [50].…”

“…Patients were middle aged, with a higher proportion of women. The majority of patients was addressed to the CIC by the emergency unit of the hospital or by private practitioners which is in accordance with previous findings [15,22,50,51,53], because the patients had attempted to commit suicide, had suicidal ideation or presented depressed mood due to relational difficulties either in their family, in their couple or at their work place. Most of the patients were diagnosed as presenting a depressive or neurotic disorder with low global functioning and were administered a polypharmacological treatment.…”

“…However, previous studies conducted in similar crisis centers reported lower rates of premature termination, i.e. from 16% to 37.5% [14,50,51]. This difference may be explained by the fact that patients having already started to work before the end of the crisis intervention may have found irrelevant to come back to the CIC for research purposes.…”

Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review

“…Interruptions in psychiatric care are frequent in the context of the usual functioning of the psychiatric care system (38,39). They lead to a large number of negative consequences for people with psychological disorders (relapses, suicidal behaviour, lack of access to medical care, psychosocial disintegration, isolation, etc.)…”

Assurer les soins aux patients souffrant de troubles psychiques en France pendant l’épidémie à SARS-CoV-2

“…Du fait de la nécessité de libérer des unités intra-hospitalières pour faire face à l'épidémie, un certain nombre de patients ont vu leur sortie de l'hôpital anticipée en faveur d'un suivi extrahospitalier au cours des derniers jours. Les ruptures de soins en psychiatrie sont fréquentes en contexte de fonctionnement habituel du système de soins psychiatriques (38,39). Elles entraînent un nombre important de conséquences négatives pour les personnes atteintes de troubles psychiques (rechutes, conduites suicidaires, défaut d'accès aux soins médicaux, désinsertion psychosociale, isolement, etc.)…”