Emerging adults discontinue behavioral health treatment at rates ranging from 30% to 50%. This study explored dropout using semi-structured interviews (N = 20). Participants were engaged in a group therapy program, Healthy Transitions. Findings revealed the lack of therapeutic relationship and logistical issues such as cost, transportation, and conflicting work schedules contributed to dropout. Participants indicated that alleviating logistical barriers and feeling a connection to their peers and group leader prevented dropout. This program was free, transportation was provided, and sessions were in the evening. Participants expressed peer educators made them feel less judged and/or stigmatized than a one-on-one therapy appointment. These findings reinforce logistical issues and lack of a therapeutic relationship contribute to dropout and highlight the benefits of flexible scheduling and reinforce the importance of a therapeutic relationship in preventing dropout.
AltmanD. G. (1991). Practical statistics for medical research. Chapman & Hall.
2.
AndersenR.NewmanJ. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly. Health and Society, 5, 95–124. https://doi.org/10.1111/j.1468-0009.2005.00428.x
3.
BabitschB.GohlD.von LengerkeT. (2012). Re-revisiting Andersen’s behavioral model of health services use: A systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine, 9, 11–28. https://doi.org/10.3205/psm000089
4.
BaekelandF.LundwallL. (1975). Dropping out of treatment: A critical review. Psychological Bulletin, 82, 738–783. https://doi.org/10.1037/h0077132
5.
BarnicotK.KatsakouC.BhattiN.SavillM.FearnsN.PriebeS. (2012). Factors predicting the outcome of psychotherapy for borderline personality disorder: A systematic review. Clinical Psychology Review, 32(5), 400–412. https://doi.org/10.1016/j.cpr.2012.04.004
6.
BarrettM. S.ChuaW.-J.Crits-ChristophP.GibbonsM. B.ThompsonD. (2008). Early withdrawal from mental health treatment: Implications for psychotherapy practice. Psychotherapy: Theory, Research, Practice, Training, 45(2), 247–267. https://doi.org/10.1037/a0016184
7.
BerghoferG.SchmidlF.RudasS.SteinerE.SchmitzM. (2002). Predictors of treatment discontinuity in outpatient mental health care. Social Psychiatry and Psychiatric Epidemiology, 37, 276–282. https://www.doi.org/10.1007/s001270200020
8.
BernardH. R.WutichA.RyanG. W. (2016). Analyzing qualitative data: Systematic approaches. SAGE.
9.
BlackwellD. L.LucasJ. W.ClarkeT. C. (2014). Summary health statistics for U.S. adults: National health interview survey, 2012. Vital Health Statistics, 260(3), 1–161.
10.
CooperA. A.StrunkD. R.RyanE. T.DeRubeisR. J.HollonS. D.GallopR. (2016). The therapeutic alliance and therapist adherence as predictors of dropout from cognitive therapy for depression when combined with antidepressant medication. Journal of Behavior Therapy and Experimental Psychiatry, 50, 113–119. https://doi.org/10.1016/j.jbtep.2015.06.005
11.
DingerU.Zilcha-ManoS.McCarthyK. S.BarrettM. S.BarberJ. P. (2013). Interpersonal problems as predictors of alliance, symptomatic improvement and premature termination in treatment of depression. Journal of Affective Disorders, 151(2), 800–803. https://doi.org/10.1016/j.jad.2013.07.003
12.
DixonL. B.HoloshitzY.NosselI. (2016). Treatment engagement of individuals experiencing mental illness: Review and update. World Psychiatry, 15(1), 13–20. https://doi.org/10.1002/wps.20306
13.
EdlundM. J.WangP. S.BerglundP. A.KatzS. J.LinE.KesslerR. C. (2002). Dropping out of mental health treatment: Patterns and predictors among epidemiological survey respondents in the United States and Ontario. American Journal of Psychiatry, 159, 845–851. https://doi.org/10.1176/appi.ajp.159.5.845
14.
GearingR. E.TownsendL.ElkinsJ.El-BasselN.OsterbergL. (2014). Strategies to predict, measure, and improve psychosocial treatment adherence. Harvard Review of Psychiatry, 22(1), 31–45. https://doi.org/10.1097/HRP.10.1097/HRP.0000000000000005
15.
GuestG.MacQueenK. M.NameyE. E. (2011). Applied thematic analysis. SAGE.
16.
GuestG.NameyE. E.MitchellM. L. (2012). Collecting qualitative data: A field manual for applied research. SAGE.
17.
HatchettG. T.HanK.CookerP. G. (2002). Predicting premature termination from counseling using the Butcher Treatment Planning Inventory. Assessment, 9(2), 156–163. https://doi.org/10.1177/10791102009002006
18.
HenzenA.MoeglinC.GiannakopoulosP.SentissiO. (2016). Determinants of dropout in a community-based mental health crisis centre. BMC Psychiatry, 16(1), 1–7. https://doi.org/10.1186/s12888-016-0819-4
19.
KhareS. R.VedelI. (2019). Recall bias and reduction measures: An example in primary health care service utilization. Family Practice, 36(5), 672–676. https://doi.org/10.1136/jech.2006.059394
20.
KoffelE. A.KoffelJ. B.GehrmanP. R. (2015). A meta-analysis of group cognitive behavioral therapy for insomnia. Sleep Medicine Reviews, 19, 6–16. https://doi.org/10.1016/j.smrv.2014.05.001
21.
KolbD. L.BeutlerL. E.DavisC. S.CragoM.ShanfieldS. B. (1985). Patient and therapy process variables relating to dropout and change in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 22(4), 702–710. https://doi.org/10.1037/h0085556
22.
KornfieldS. L.Kang-YiC. D.MandellD. S.EppersonC. N. (2018). Predictors and patterns of psychiatric treatment dropout during pregnancy among low-income women. Maternal and Child Health Journal, 22(2), 226–236. https://doi.org/10.1007/s10995-017-2394-9
23.
LoTempioE.ForsbergS.BrysonS. W.FitzpatrickK. K.Le GrangeD.LockJ. (2013). Patients’ characteristics and the quality of the therapeutic alliance in family-based treatment and individual therapy for adolescents with anorexia nervosa. Journal of Family Therapy, 35, 29–52. https://doi.org/10.1111/1467-6427.12011
24.
MerikangasK. R.HeJ.BursteinM.SwendsenJ.AvenevoliS.CaseB.GeorgiadesK.HeatonL.SwansonS.OlfsonM. (2011). Service utilization for lifetime mental disorders in US adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 50(1), 32–45. https://doi.org/10.1016/j.jaac.2010.10.006
25.
MeyerO. L.SawA.ChoY. I.FancherT. L. (2015). Disparities in assessment, treatment, and recommendations for specialty mental health care: Patient reports of medical provider behavior. Health Services Research, 50(3), 750–767. https://doi.org/10.1111/1475-6773.12261
26.
MottJ. M.HundtN. E.SansgiryS.MignognaJ.CullyJ. A. (2014). Changes in psychotherapy utilization among veterans with depression, anxiety, and PTSD. Psychiatric Services, 65(1), 106–112. https://doi.org/10.1176/appi.ps.201300056
27.
NaslundJ. A.AschbrennerK. A.MarschL. A.BartelsS. J. (2016). The future of mental health care: Peer-to-peer support and social media. Epidemiology and Psychiatric Sciences, 25(2), 113–122. https://doi.org/10.1017/S2045796015001067
28.
O’ConnorP. J.MartinB.WeeksC. S.OngL. (2014). Factors that influence young people’s mental health help-seeking behaviour: A study based on the Health Belief Model. Journal of Advanced Nursing, 70(11), 2577–2587. https://doi.org/10.1111/jan.12423
29.
RickettsT. C.GoldsmithL. J. (2005). Access in health services research: The battle of the frameworks. Nursing Outlook, 53(6), 274–280. https://doi.org/10.1016/j.outlook.2005.06.007
30.
SeveliusJ. M.PatouhasE.KeatleyJ. G.JohnsonM. O. (2014). Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Annals of Behavioral Medicine, 47(1), 5–16. https://doi.org/10.1007/s12160-013-9565-8
31.
Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. https://www.samhsa.gov/data
32.
SwiftJ. K.GreenbergR. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547–559. https://doi.org/10.1037/a0028226
33.
WangH. R.WooY. S.JunT.-Y.BahkW. M. (2015). Predictors of premature discontinuation of outpatient treatment after discharge of patients with posttraumatic stress disorder. Neuropsychiatric Disease and Treatment, 11, 787–792. https://doi.org/10.2147/NDT.S78212
