Predictors of Treatment Attrition Among Adult Outpatients With Clinically Significant Suicidal Ideation

Abstract

Findings suggest that clinician-assessed poorer overall functioning and a substance use disorder diagnosis are risk factors for attrition among suicidal individuals, above and beyond other symptom measures. Further research is warranted to investigate attrition in additional outpatient samples.

Determinants of treatment disengagement among those at risk of suicide referred to primary mental health care services in Western Sydney, Australia

“…Sociodemographic variables such as gender, marital status and employment status were not strongly associated with service non-attendance or early service cessation, similar to previous studies (Hom and Joiner, 2017). However, our findings indicated, although not significant in 95% confidence level, those with poorer English-language skills were more likely to attend for an initial treatment session, but were also more likely to disengage with services prematurely.…”

“…Identifying the characteristics among those at risk of suicide who are more likely to disengage with mental health services can inform strategies to facilitate continued contact with services. However, there are few studies that investigate factors associated with disengagement among those who are assessed as being at risk of suicide (Hom and Joiner, 2017), with most studies focussing on individuals referred to mental health services in general. It is not clear whether the sociodemographic, economic and service-level factors (Fenger et al, 2011; Kruse and Rohland, 2002; Marshall et al, 2016; Mitchell and Selmes, 2007; Reitzel et al, 2006; Self et al, 2005) associated with treatment disengagement in these studies are similar among individuals assessed as being at risk of suicide.…”

Examining the characteristics and clinical features of in‐ and between‐session suicide risk assessments among psychiatric outpatients

“…First, it is noteworthy that participants in this study represented a sample of outpatients with relatively severe clinical presentations. More than half reported a suicide attempt history, and the majority presented with comorbid psychiatric disorders, the presence of which has been consistently associated with poor treatment engagement and attrition (Barrett et al., ; Swift & Greenberg, ), including among suicidal individuals (Hom & Joiner, ). Suicidal ideation, death ideation, and access to means for suicide were also reported for the majority of risk assessments conducted.…”

Considerations in the assessment of help‐seeking and mental health service use in suicide prevention research

“…Capturing the steps that precede mental health service use may illuminate targets for interventions designed to enhance service use among at‐risk individuals. Likewise, examining the degree to which at‐risk individuals continue to engage with care after initiation of services may provide insights into how treatment retention might be improved among this population—a group for which treatment attrition is a particular concern (Clark & Fawcett, 1992; Hom & Joiner, 2017; Rudd et al, 1995). If the field’s goal is ultimately to reduce risk and improve quality of life for at‐risk individuals, it is critical that we evaluate not only whether at‐risk individuals have attended/utilized a mental healthcare visit but also whether they have remained engaged in care and experienced a reduction in suicidal symptoms (Lizardi & Stanley, 2010).…”