Patient factors predicting early dropout from psychiatric outpatient care for borderline personality disorder

Panfilis, Chiara De; Marchesi, Carlo; Cabrino, Chiara; Monici, Alberto; Politi, Virginia; Rossi, Matteo A. C.; Maggini, Carlo

doi:10.1016/j.psychres.2012.03.016

Cited by 27 publications

(13 citation statements)

References 59 publications

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“…Importantly, the diagnoses of anxiety disorder and personality disorder were significant predictors of dropouts. It is possible that this is due to the difficulty of anxious patients to overcome their fears or for the emotionally labile patients to maintain stable interpersonal bonds [ 18 , 19 , 21 ]. In 2012, Martino et al showed that both borderline personality disorders and subjective experience (motivation, treatment expectation, therapeutic relation perception and barriers to access) predict premature termination of treatment.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Discussionmentioning

confidence: 99%

“…Schizophrenia could also increase the risk of drop out [ 20 ]. De Panfilis et al [ 21 ] showed that a history of suicide attempts predicted early discontinuation of therapy, whereas the presence of an eating disorder and avoidant personality features were negatively associated with early dropout.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…In studies of treatment dropout with consumers with BPD, predictors of dropout include anger [5–7], high levels of hostility [7], impulsiveness [5, 6], higher trait anxiety [5], higher baseline experiential avoidance [5], and history of a least one suicide attempt [8]. Similar to the broader psychotherapy dropout literature, younger age [9–14] and lack of motivation for change [6, 7, 11, 13, 15–18] are also predictors of dropout in consumers with BPD.…”

Section: Introductionmentioning

confidence: 99%

Predicting dropout in outpatient dialectical behavior therapy with patients with borderline personality disorder receiving psychiatric disability

Landes

Chalker

Comtois

2016

bord personal disord emot dysregul

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BackgroundRates of treatment dropout in outpatient Dialectical Behavior Therapy (DBT) in the community can be as high as 24 % to 58 %, making dropout a great concern. The primary purpose of this article was to examine predictors of dropout from DBT in a community mental health setting.MethodsParticipants were 56 consumers with borderline personality disorder (BPD) who were psychiatrically disabled participating in a larger feasibility trial of Dialectical Behavior Therapy- Accepting the Challenges of Exiting the System. The following variables were examined to see whether they predicted dropout in DBT: age, education level, baseline level of distress, baseline level of non-acceptance of emotional responses, and skills module in which a consumer started DBT skills group. These variables were chosen based on known predictors of dropout in consumers with BPD and in DBT, as well as an interest in what naturally occurring variables might impact dropout.ResultsThe dropout rate in this sample was 51.8 %. Results of the logistic regression show that younger age, higher levels of baseline distress, and a higher level of baseline non-acceptance of emotional responses were significantly associated with dropout. The DBT skills module in which an individual started group did not predict dropout.ConclusionsThe implications of these findings are that knowledge of consumer age and pretreatment levels of distress and non-acceptance of emotional responses can impact providers’ choice of commitment and treatment strategies to reduce dropout. Future research should examine these strategies, as well as the impact of predictor variables on outcome and reasons for dropout.

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“…24,25 Access to treatment is limited, and dropout rates are high (15-77%). 26 The NHMRC guidelines provide advice that can be implemented when referral to specialist services for borderline personality disorder is unavailable.…”

Section: Treatmentmentioning

confidence: 99%