Research That Matters (January 17 - 20, 2008)


Empire Ballroom (Omni Shoreham)

Predictors of Outpatient Treatment Adherence in Patients with Mood Disorders

Dana Lizardi, PhD, Columbia University, Jill Harkavy-Friedman, PhD, Columbia University, Ainsley Burke, PhD, Columbia University, Maria A. Oquendo, MD, Columbia University, J. John Mann, MD, Columbia University, and Barbara Stanley, Columbia University.

Abstract

Background and Purpose: Premature drop-out from outpatient psychiatric treatment has long been recognized as a serious problem. In studies of depressed patients, rates of drop-out range from 15% to over 50%, with the majority falling between 20% and 40%. Treatment drop-out is particularly problematic among depressed suicide attempters. Up to 60% of attempters drop out of treatment after just one week of outpatient therapy. Of those who do attend treatment, after 3 months of being hospitalized for a suicide attempt, 38% of attempters will no longer be attending outpatient treatment, and after a year, 73% of attempters will no longer be attending any treatment. The risk of repeat attempts and possible completed suicide can be reduced if suicide attempters engage in effective outpatient treatment. This study sought to identify patient characteristics associated with treatment adherence and, specifically, to determine whether rates of treatment adherence among depressed patients vary by ethnicity, suicide attempt status, and severity of depression. Being able to identify the characteristics that indicate the likelihood of an individual engaging in outpatient treatment is essential. This knowledge would facilitate focused intervention, targeting those most at risk for dropping out and, thereby, reducing repeat suicide attempts.

Methods: This study was conducted through the Silvio O. Conte Center, Department of Psychiatry, New York State Psychiatric Institute. Analyses were funded through the Developing Center on Interventions for the Prevention of Suicide (DCIPS) (P20 AA015630), Department of Psychiatry, New York State Psychiatric Institute. 518 subjects presenting for treatment of a depressive illness (MDD or bipolar disorder with a current major depressive episode) were assessed during their index hospitalization and given follow-up assessments at three months and one year. Logistic regressions were conducted examining multiple socio-demographic and clinical characteristics (including age, gender, marital status, number of children, ethnicity, diagnosis, suicide attempt status, and severity of depression) as predictors of adherence at the two follow-up periods.

Results: Of the 518 subjects evaluated at baseline, 303 participated at the three month follow-up and 273 participated at the one year follow-up. 85 (16.2%) subjects had dropped out of treatment at the three month follow-up period and 75 (14.3%) subjects had dropped out of treatment at the one year follow-up period. At 3 months, age(OR=.936, p<.001), ethnicity (OR=3.640, p=.004), and education (OR=1.244, p=.001) were significant predictors of outpatient treatment adherence with older age, non-caucasian ethnicity, and fewer years of education predicting decreased adherence to outpatient treatment. At one year, age (OR=.932, p<.001), ethnicity (OR=2.762, p=.047), and education (OR=1.294, p=.001) remained significant predictors. Unexpectedly, suicide attempt status and severity of depresion were not significant predictors of outpatient treatment adherence at either time period.

Conclusions and Implications: Older, Non-Caucasian patients with less education were consistently most likely to drop-out of treatment. Engagement interventions should be proactive in targeting patients with these characteristics, as at they are at high risk for treatment drop-out and, thus, repeat attempts. Implications for social work practice and research are discussed.