Dropout from randomised controlled trials of psychological treatments for depression in children and youth: a systematic review and meta-analyses

Wright, Isobel; Mughal, Fahim; Bowers, Gemma; Meiser‐Stedman, Richard

doi:10.1016/j.jad.2020.11.039

Cited by 19 publications

(16 citation statements)

References 32 publications

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“…Results found that dropout from RCTs has tended to be relatively low, with all dropout estimates below 15.5%. These compare favourably with the mean dropout rate (28.4%) found by de Haan, Boon, de Jong, Hoeve, and Vermeiren ( 2013 ) in their meta-analysis of children and young people dropping out from treatment in psychotherapy efficacy studies, and are in a similar order to the recent meta-analytic findings of dropout among children and young people from psychotherapeutic interventions for depression (14.9%) (Wright, Mughal, Bowers, & Meiser-Stedman, 2021 ). They are also comparable to recent adult population meta-analyses that related specifically to PTSD: 16% (Lewis et al, 2020 ) and 18% (Imel et al, 2013 ).…”

Section: Discussionsupporting

confidence: 71%

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A meta-analysis of dropout from evidence-based psychological treatment for post-traumatic stress disorder (PTSD) in children and young people

Simmons

Meiser‐Stedman

Baily

et al. 2021

European Journal of Psychotraumatology

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Background Despite the established evidence base of psychological interventions in treating PTSD in children and young people, concern that these trauma-focused treatments may ‘retraumatise’ patients or exacerbate symptoms and cause dropout has been identified as a barrier to their implementation. Dropout from treatment is indicative of its relative acceptability in this population. Objective Estimate the prevalence of dropout in children and young people receiving a psychological therapy for PTSD as part of a randomized controlled trial (RCT). Methods A systematic search of the literature was conducted to identify RCTs of evidence-based treatment of PTSD in children and young people. Proportion meta-analyses estimated the prevalence of dropout. Odds ratios compared the relative likelihood of dropout between different treatments and controls. Subgroup analysis assessed the impact of potential moderating variables. Results Forty RCTs were identified. Dropout from all treatment or active control arms was estimated to be 11.7%, 95% CI [9.0, 14.6]. Dropout from evidence-based treatment (TFCBTs and EMDR) was 11.2%, 95% CI [8.2, 14.6]. Dropout from non-trauma focused treatments or controls was 12.8%, 95% CI [7.6, 19.1]. There was no significant difference in the odds of dropout when comparing different modalities. Group rather than individual delivery, and lay versus professional delivery, were associated with less dropout. Conclusions Evidence-based treatments for children and young people with PTSD do not result in higher prevalence of dropout than non-trauma focused treatment or waiting list conditions. Trauma-focused therapies appear to be well tolerated in children and young people.

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Section: Discussionsupporting

confidence: 71%

“…Yearwood, Vliegen, Chau, Corveleyn, & Luyten, 2019 ). It may be important to note that this finding is in contrast to the lack of difference between individual and group-based interventions observed for dropout from psychological treatments for depression in children and adolescents (Wright et al, 2021 ).…”

Section: Discussionmentioning

confidence: 62%

A meta-analysis of dropout from evidence-based psychological treatment for post-traumatic stress disorder (PTSD) in children and young people

Simmons

Meiser‐Stedman

Baily

et al. 2021

European Journal of Psychotraumatology

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“…Furthermore, a total of 13.3 percent of the patients dropped out from treatment. This is comparable with results of meta-analysis that found drop-out rates of 11.7 percent from trauma therapy [52] and 14.6 percent for treatment of depression [65]. Yet, a drop-out prevalence of 13.3 percent in the current effectiveness trial is substantially lower than reported in the meta-analysis of de Haan and colleagues [18], which found a drop-out prevalence in trauma treatments of 50 percent in effectiveness studies and 28.4 percent in efficacy studies.…”

Section: Discussionsupporting

confidence: 87%

Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors

Skar

Braathu

Jensen

et al. 2022

BMC Health Serv Res

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Background There is a paucity of evidence about effective implementation strategies to increase treatment response and prevent drop-out among children receiving evidence-based treatment. This study examines patient, therapist, and implementation factors and their association to nonresponse and drop-out among youth receiving Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Methods Youth (n = 1240) aged 6–18 (M = 14.6) received TF-CBT delivered by 382 TF-CBT therapists at 66 clinics. Odds ratio analyses were used to investigate whether pretreatment child (age, gender, number of trauma experiences, post-traumatic stress symptoms (PTSS), therapist (education), and implementation strategy factors (high-low, low-low, low–high intensity therapist and leadership training respectively) or tele-mental health training during the Covid-19 pandemic are associated with nonresponse (above clinical PTSS level post-treatment) and drop-out (therapist-defined early termination). Fidelity checks were conducted to ensure that TF-CBT was used consistently. Results One fourth of the children (24.4%) were nonresponders and 13.3 percent dropped out. Exposure to three or more traumatic experiences were related to nonresponse and drop-out. Higher baseline PTSS was related to a higher probability of nonresponse. There was no effect of therapist education or child gender on nonresponse and drop-out, whereas children over 15 years had a higher likelihood of both. After controlling for baseline PTSS, the effect of age on nonresponse was no longer significant. Drop-out was related to fewer sessions, and most dropped out during the first two phases of TF-CBT. Fidelity was high throughout the different implementation phases. High-intensity therapist training was related to a lower probability of both nonresponse and drop-out, whereas low therapist and leadership training were related to a higher likelihood of both. Multivariate analysis revealed higher child age and higher PTSS baseline scores as significant predictors of nonresponse, and number of trauma experiences (> = 3) at baseline as the only predictor of drop-out. Conclusions High-intensity therapist training seem key to prevent patient nonresponse and drop-out. Leadership training might positively affect both, although not enough to compensate for less intensive therapist training. More complex cases (higher PTSS and exposure to more traumas) predict nonresponse and drop-out respectively, which underscores the importance of symptom assessment to tailor the treatment. The lack of predictive effect of therapist education increases the utilization of TF-CBT. Trial registration Retrospectively registered in ClinicalTrials, ref. nr. NCT05248971.

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“… 15 Whereas, longer treatment duration was associated with higher attrition rates in trials of interventions for depression in adults, 16 but no relationships were identified between dropout rates and types of interventions in children with depression. 14 These findings suggest that features of the intervention (eg, duration), as well as the study population (eg, age group), may be important when considering feasibility and acceptability in trials. A previous meta-analyses of 43 studies concerning non-pharmacological interventions reported an attrition rate ranging from 0–63% in trials involving people with schizophrenia, 13 while a composite dropout rate of 13% was reported in trials of people with a schizophrenia spectrum disorder in a meta-analysis of 74 studies.…”

Section: Introductionmentioning

confidence: 99%

“…Growing a high-quality evidence base concerning psychosocial interventions for early and emerging psychosis is paramount for informing the selection of efficacious and acceptable interventions. These efforts are hindered by a paucity of knowledge concerning feasibility for non-pharmacological interventions across a range of conditions 13 14. This is a gap to address, particularly given age of onset in early and emerging psychosis, as previous studies conducted in young people and adults with depression indicate that certain types of interventions (ie, cognitive–behavioural approaches) may have lower study attrition rates 15.…”

Section: Introductionmentioning

confidence: 99%

Recruitment, attrition and intervention completion in clinical trials of psychosocial interventions involving people with early and emerging psychosis: a systematic review protocol

et al. 2022

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IntroductionPsychosocial interventions for people experiencing early and emerging psychosis have demonstrated efficacy in reducing symptom severity and supporting recovery; however, much remains unknown about optimising treatment and future research trials are required. Gaining a better understanding of feasibility in trials of psychosocial interventions involving this population would inform the design and planning of future research and support the development of high-quality evidence. The aim of this systematic review is to evaluate the recruitment rate, study attrition rates and intervention completion of psychosocial intervention randomised controlled trial studies involving people with early and emerging psychosis.Methods and analysisThe systematic review will be reported in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols 2015 guideline. The Cochrane Library, PubMed, Medline, PsycINFO, Web of Science and CINAHL databases will be searched from inception to September 2021 to identify potentially relevant studies. The title and abstracts of returned records will be assessed for eligibility against the inclusion/exclusion criteria by two reviewers, independently, and records which appear eligible will be included. The full texts of included records will then be assessed using the same procedure. Qualitative and quantitative synthesis will be undertaken. Proportion meta-analyses will be used to calculate the recruitment rate, study attrition rate and intervention completion rate, while subgroup analyses will explore differences among subgroups of study and intervention characteristics.Ethics and disseminationThis study will collate and analyse anonymised data from published research and therefore, ethical approval is not necessary. Study results will be disseminated via publication in academic journals.

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Dropout from randomised controlled trials of psychological treatments for depression in children and youth: a systematic review and meta-analyses

Cited by 19 publications

References 32 publications

A meta-analysis of dropout from evidence-based psychological treatment for post-traumatic stress disorder (PTSD) in children and young people

A meta-analysis of dropout from evidence-based psychological treatment for post-traumatic stress disorder (PTSD) in children and young people

Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors

Recruitment, attrition and intervention completion in clinical trials of psychosocial interventions involving people with early and emerging psychosis: a systematic review protocol

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