Should I stay or must I go? Predictors of dropout in an internet-based psychotherapy programme for posttraumatic stress disorder in Arabic

Abstract

Background: Dropout from psychotherapy has negative impacts on clients, therapists, and health-care agencies. Research has identified a variety of variables as predictors of dropout, which can be grouped in three domains: socio-demographic, psychological, and treatmentrelated variables. Objective: In order to further clarify the question of predictors of dropout, an exploratory research design was applied to a large sample, testing 25 different variables from the three domains as possible predictors. Method: The sample included 386 adults who started an internet-based cognitivebehavioural treatment approach for posttraumatic stress disorder (PTSD) in Arabic. As the participants had different countries of origin and of current residence, multilevel analyses were performed. For the selection of predictor variables, the Least Absolute Shrinkage and Selection Operator was used. Results: Dropout rates did not vary significantly between participants from different countries of origin or from different countries of residence. Likewise, dropout did not vary significantly between clusters of individuals with the same country of origin and the same country of residence, i.e. the same migration path. Three of the 25 variables were identified as significant predictors for dropout: marital status (divorced participants' probability to drop out was higher compared to non-divorced, i.e. single, married, or widowed, clients), treatment credibility scores (higher dropout probability of participants with lower treatment credibility), and the participants' year of registration for the treatment (earlier years of registration predicted lower dropout probability). The overall ability of the three-factormodel to discriminate between dropout and completion was poor (AUC = 0.652, with low sensitivity and acceptable specificity). Conclusions: The predictors belong to the treatment-related domain (credibility, year of registration) or are specific to the target group (marital status). However, the results show that predicting treatment dropout continues to be a very challenging endeavour and indicate that it is important to look at each intervention individually.

Is only one cognitive technique also effective? Results from a randomized controlled trial of two different versions of an internet-based cognitive behavioural intervention for post-traumatic stress disorder in Arabic-speaking countries

“…sociodemographic, psychological, design-related variables, Lewis et al, 2020 ; Swift & Greenberg, 2012 ). A dropout analysis, which includes parts of the therapies presented here, underlines this inconsistency as only three of 25 variables tested could be identified as significant predictors for dropout (marital status, treatment credibility, and the participants’ year of treatment registration, Vöhringer et al, 2020 ). Type of trauma and symptom severity were not predictive for dropout (Vöhringer et al, 2020 ).…”

“…A dropout analysis, which includes parts of the therapies presented here, underlines this inconsistency as only three of 25 variables tested could be identified as significant predictors for dropout (marital status, treatment credibility, and the participants’ year of treatment registration, Vöhringer et al, 2020 ). Type of trauma and symptom severity were not predictive for dropout (Vöhringer et al, 2020 ). Future research needs to take into account the interplay of additional variables that are specifically related both to the sociocultural context and to the components of the intervention.…”

Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review

“…Illustrated activities Daily life Rather social activities than individual activities 135 Gender-specific behaviour Gender separation in daily life 97 – 99 Religious/traditional activities Praying instead of walking with dog, having a cocktail 71 Coping strategies Added culturally relevant resources 105 , 133 3. Illustrated environment/burdens Mental health Low medical infrastructure due to war 61 , 95 , 144 Countries, politics Eventually adding information about good habits when living in Sweden, e.g., eating 63 , 134 Education Low socio-economic status, low level of parents education 139 Burdens High level of pressure for academic excellence as stressor for adolescents, lack of siblings could lead to decreased social skills, loneliness 136 4. Illustrated values/traditions Handling relationships/sexuality/marriage Changing/excluding parts related to unmarried cohabitation 79 Value/importance of family/community Include families and friends in the treatment goals to take into account possible consequences in the family and community that might be more relevant for participants than their own individual suffering 90 Value/importance of religion/respect/spirituality Include a trustful relationship with God 97 – 99 Other values Longing for their country 77 5.…”

The Opportunities and Challenges of the First Three Years of Open Up, an Online Text-Based Counselling Service for Youth and Young Adults

“…The termination point of each text-based session can be ambiguous and unpredictable [ 21 ]. Additionally, predictors of adherence and dropout in face-to-face psychological treatments have been largely inconsistent across contexts and modalities [ 26 , 27 ]. This issue is compounded by the anonymity of text-based counseling services—as information about the user’s identity is limited, there are additional difficulties in knowing whether the user is telling the truth, or in ascertaining their safety.…”