Symptoms of emotional disorders and sociodemographic factors as moderators of dropout in psychological treatment: a meta-review

• María Carpallo-Gonzalez ^[1] ; Roger Muñoz-Navarro ^[1] ; Cesar Gonzalez-Blanch ^[3] ; Antonio Cano-Vindel ^[2]
  1. [1] Universitat de València

     Universitat de València

     Valencia, España

     
  2. [2] Universidad Complutense de Madrid

     Universidad Complutense de Madrid

     Madrid, España

     
  3. [3] Hospital Marques de Valdecilla-IDIVAL, Santander

  Mostrar afiliaciones +
• Localización: International journal of clinical and health psychology, ISSN 1697-2600, Vol. 23, Nº. 4, 2023, págs. 41-50
• Idioma: inglés
• DOI: 10.1016/j.ijchp.2023.100379
• Enlaces
  • Texto completo (pdf)
• Resumen

  • Objective Dropout from psychological treatment is an important problem that substantially limits treatment effectiveness. A better understanding of this phenomenon, could help to minimize it. Therefore, we performed a systematic review of meta-analyses (MA) on dropout from psychological treatments to (1) determine the estimated overall dropout rate (DR) and (2) to examine potential predictors of dropout, including clinical symptoms (anxiety and depression) and sociodemographic factors.

    Method A literature search of the PubMed PsycINFO, Embase, Scopus and Google Scholar databases was conducted. We identified 196 MAs on dropout from psychological treatment carried out primarily in adult patients or mixed samples (adults and children) between 1990 and 2022. Of these, 12 met all inclusion criteria. Two forest plots were created to visualize the DR and the relationship between DR and the disorder.

    Results The DR ranged from 15.9% to 46.8% and was significantly moderated by symptoms of emotional disorders. The highest DR were observed in younger, unmarried patients, and those with lower educational and income levels.

    Conclusions DR in patients undergoing psychological treatment is highly heterogeneous, but higher in individuals presenting symptoms of anxiety and/or depression, especially the latter. Given that high DR undermine the effectiveness of psychological interventions, it is clear that greater efforts are needed to reduce dropout, particularly among individuals with symptoms of emotional disorders.

• Referencias bibliográficas
  • Aderka, I. M., Anholt, G. E., van Balkom, A. J., Smit, J. H., Hermesh, H., Hofmann, S. G., & van Oppen, P. (2011). Differences between...
  • Bennemann, B., Schwartz, B., Giesemann, J., & Lutz, W. (2022). Predicting patients who will drop out of out-patient psychotherapy using...
  • Bentley, K. H., Cohen, Z. D., Kim, T., Bullis, J. R., Nauphal, M., Cassiello-Robbins, C., & Barlow, D. H. (2021). The nature, timing,...
  • Botella, J., & Sanchez-Meca, J. (2015). Meta-analisis en Ciencias Sociales y de la Salud.Madrid: Editorial Síntesis.
  • Botella, J., & Zamora, A. (2017). El meta-analisis: una metodología para la investigacion en Educacion. Educacion XX1: Revista de la Facultad...
  • Bueno-Notivol, J., Gracia-García, P., Olaya, B., Lasheras, I., Lopez-Anton, R., & Santabarbara, J. (2021). Prevalence of depression during...
  • Campo-Arias, A., & Cassiani Miranda, C. A. (2008). Trastornos mentales mas frecuentes: Prevalencia y algunos factores sociodemograficos...
  • Cenat, J. M., Blais-Rochette, C., Kokou-Kpolou, C. K., Noorishad, P. G., Mukunzi, J. N., McIntee, S. E., & Labelle, P. R. (2021). Prevalence...
  • Cooper, A. A., & Conklin, L. R. (2015). Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical...
  • Cooper, A. A., Strunk, D. R., Ryan, E. T., DeRubeis, R. J., Hollon, S. D., & Gallop, R. (2016). The therapeutic alliance and therapist...
  • Cuijpers, P. (1998). Psychological outreach programmes for the depressed elderly: A meta- analysis of effects and dropout. International Journal...
  • Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023). Cognitive behavior therapy vs....
  • Cuijpers, P., Quero, S., Dowrick, C., & Arroll, B. (2019). Psychological treatment of depres- sion in primary care: Recent developments....
  • DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: A meta-analysis. Health Psychology, 23(2), 207. doi:10.1037/0278-6133.23.2.207.
  • DiMatteo, M. R., Haskard, K. B., & Williams, S. L. (2007). Health beliefs, disease severity, and patient adherence: A meta-analysis. Medical...
  • Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude,...
  • Fernandez-Arias, I., Bernaldo-de Quiros, M., Labrador, F. J., Estupiña, F. J., &Labrador- Mendez, M. (2019). Factors interfering with...
  • Fernandez Arias, I. G., García Fernandez, G., Bernaldo de Quiros Aragon, M., Estupiña Puig, F. J., Labrador Encinas, F. J., & Labrador...
  • Gersh, E., Hallford, D. J., Rice, S. M., Kazantzis, N., Gersh, H., Gersh, B., & McCarty, C. A. (2017). Systematic review and meta-analysis...
  • Hans, E., & Hiller, W. (2013). Effectiveness of and dropout from outpatient cognitive behavioral therapy for adult unipolar depression:...
  • Harvey, A. G., & Gumport, N. B. (2015). Evidence-based psychological treatments for men- tal disorders: Modifiable barriers to access and...
  • Hatchett, G. T., & Park, H. L. (2003). Comparison of four operational definitions of premature termination. Psychotherapy: Theory, Research,...
  • Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando, FL: Academic Press.
  • Henzen, A., Moeglin, C., Giannakopoulos, P., & Sentissi, O. (2016). Determinants of drop- out in a community-based mental health crisis...
  • Higgins, J. P., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21(11), 1539–1558.
  • Imel, Z. E., Laska, K., Jakupcak, M., & Simpson, T. L. (2013). Meta-analysis of dropout in treatments for posttraumatic stress disorder....
  • Karyotaki, E., Kleiboer, A., Smit, F., Turner, D. T., Pastor, A. M., Andersson, G., & Cuijpers, P. (2015). Predictors of treatment dropout...
  • Lamers, F., Hoogendoorn, A. W., Smit, J. H., van Dyck, R., Zitman, F. G., Nolen, W. A., & Penninx, B. W. (2012). Sociodemographic and...
  • Leeuwerik, T., Cavanagh, K., & Strauss, C. (2019). Patient adherence to cognitive behavioural therapy for obsessive compulsive disorder:...
  • Lewis, S., & Clarke, M. (2001). Forest plots: Trying to see the wood and the trees. British Medical Journal, 322(7300), 1479–1480. doi:10.1136/bmj.322.7300.1479.
  • Lewis, C., Roberts, N. P., Gibson, S., & Bisson, J. I. (2020). Dropout from psychological therapies for posttraumatic stress disorder...
  • Lopez-Lopez, J. A., Rubio-Aparicio, M., & Sanchez-Meca, J. (2022). Overviews of reviews: Concept and development. Psicothema, 34(2), 175–181.
  • Magrin, M. E., D’addario, M., Greco, A., Miglioretti, M., Sarini, M., Scrignaro, M., & Crocetti, E (2015). Social support and adherence...
  • Murphy, S. T., Garcia, R. A., Cheavens, J. S., & Strunk, D. R. (2022). The therapeutic alli- ance and dropout in cognitive behavioral...
  • Newcombe, R. G. (2012). Confidence intervals for proportions and related measures of effect size. CRC Press.
  • Ong, C. W., Lee, E. B., & Twohig, M. P. (2018). A meta-analysis of dropout rates in accep- tance and commitment therapy. Behaviour Research...
  • Pollock, M., Fernandes, R. M., Becker, L. A., Pieper, D., & Hartling, L. (2021). Overviews of reviews. In J. P. T. Higgins, J. Thomas,...
  • Santabarbara, J., Lasheras, I., Lipnicki, D. M., Bueno-Notivol, J., Perez-Moreno, M., Lopez-Anton, R., & Gracia-García, P. (2021). Prevalence...
  • Schultz, A., Goertzen, L., Rothney, J., Wener, P., Enns, J., Halas, G., & Katz, A. (2018). A scoping approach to systematically review...
  • Seekles, W., Cuijpers, P., Kok, R., Beekman, A., Van Marwijk, H., & Van Straten, A. (2013). Psychological treatment of anxiety in primary...
  • Sharf, J. (2009). Meta-analysis of psychotherapy dropout. Research Gate. https://www. researchgate.net/publication/307557461_Metaanalysis_of_Psychotherapy_Dropout.
  • Stubbs, B., Vancampfort, D., Rosenbaum, S., Ward, P. B., Richards, J., Soundy, A., & Schuch, F. B. (2016). Dropout from exercise randomized...
  • Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and...
  • Swift, J. K., & Greenberg, R. P. (2014). A treatment by disorder meta-analysis of dropout from psychotherapy. Journal of Psychotherapy...
  • Swift, J. K., Greenberg, R. P., Tompkins, K. A., & Parkin, S. R. (2017). Treatment refusal and premature termination in psychotherapy,...
  • Torous, J., Lipschitz, J., Ng, M., & Firth, J. (2020). Dropout rates in clinical trials of smart- phone apps for depressive symptoms:...
  • Viechtbauer, W. (2010). Conducting meta-analyses in R with the metafor package. Journal of Statistical Software, 36, 1–48. doi:10.18637/jss.v036.i03.
  • Whiteford, H. A., Ferrari, A. J., Degenhardt, L., Feigin, V., & Vos, T. (2015). The global burden of mental, neurological and substance...
  • Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2),...
  • Wittchen, H., & Jacobi, F. (2005). Size and burden of mental disorders in Europe—a criti- cal review and appraisal of 27 studies. European...
  • Wittchen, H., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jonsson, B., & Faravelli, C. (2011). The size and burden of mental...
  • World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. World Health Organization.
  • Zimmermann, D., Rubel, J., Page, A. C., & Lutz, W. (2017). Therapist effects on and predic- tors of non-consensual dropout in psychotherapy....