Treatment adherence in adolescent psychiatric inpatients with severe disruptive behaviour

Abstract

Objective To examine pre‐treatment characteristics associated with dropout in 224 adolescent psychiatric inpatients (mean age 17.1 years) with severe disruptive behaviour. To date, little is known about the factors predicting dropout among adolescents treated for severe disruptive behaviour. This is surprising, as dropout is a major problem in this specific group. Method Dropouts (n = 77) and completers (n = 147) were compared on known risk factors for dropout, such as severity of externalising problems and disorders, ethnic minority status, male gender, and lower academic functioning, as well as on other factors considered relevant: behavioural characteristics, including age of onset and different types of disruptive behaviour. Within dropout, withdrawal (termination against the advice of the therapist; n = 40) and pushout (termination against the wish of the client; n = 37) were distinguished. Results Two characteristics significantly predicted dropout: early onset of disruptive behaviour and cannabis usage prior to treatment. Within the dropout group no differences were found between withdrawals and pushouts. Conclusions Predicting dropout among adolescent psychiatric inpatients with severe disruptive behaviour is difficult. The two predictors found were already present at the time of admission and are therefore considered unalterable. However, they can be used to pinpoint individuals with higher chance at dropout, who in turn can be offered tailored interventions aimed at improving the therapeutic relationship.

Schema therapy for violent PD offenders: a randomized clinical trial

“…Patients were free to refuse the study or to withdraw at any time, without consequences. Dropout was defined as withdrawing from the study at the patient's request, and pushout (De Boer, Boon, De Haan, & Vermeiren, 2016 ) as withdrawing at treatment or research staff's request ( Fig. 1 ).…”

Therapeutic Relationship and Dropout in High-Risk Adolescents’ Intensive Group Psychotherapeutic Programme

“…Premature termination of therapy is therefore considered a serious problem (Armbruster and Kazdin, 1994;Midgley and Navridi, 2006;Gopalan et al, 2010). Dropout percentages of 38.4% for outpatients (De Haan et al, 2015) and 34.4% for inpatients (De Boer et al, 2016) were found in adolescent mental health care. An important determinant for dropout is the quality of the therapeutic (patient-therapist) relationship (Kazdin and Wassell, 1998;Garcia and Weisz, 2002;Hawley and Weisz, 2005;Stevens et al, 2006;De Haan et al, 2013;Owen et al, 2016).…”