Examining trauma, anxiety, and depression as predictors of dropout from residential treatment for substance use disorders.

Substance use disorders (SUDs) are highly prevalent and have deleterious effects on one's health and well-being. Inpatient treatment for SUDs reduces patient relapse, which subsequently ameliorates these negative effects on the individual and society. Additionally, those who complete treatment are less likely to relapse compared to those who do not complete treatment. Thus, maintaining patient engagement in treatment and reducing the rates of those leaving against medical advice (AMA) is particularly important. Examining the factors and comorbidities that may contribute to treatment dropout has the potential to identify at-risk patients in need of additional individualized intervention. The current study aimed to examine comorbid anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms as predictors of dropout AMA in a residential substance use treatment population. Results showed that patients with social anxiety were more likely to leave treatment AMA, while those with PTSD were more likely to complete treatment. Findings suggest that PTSD-specific treatment, as offered in this facility, may help with patient retention, while group focused therapy may be distressing to those with social anxiety. Clinical implications of this research may include incorporating evidence-based practice for social anxiety early during inpatient treatment to reduce anxiety such that patients may better engage with SUDs treatment.

Effectiveness of prolonged exposure (PE) after implementation at a crime victim support centre.

Background: Recent practice guidelines strongly recommend evidence-based psychotherapies (EBPs) as the first-line treatment for post-traumatic stress disorder (PTSD). However, previous studies found barriers to the implementation of EBPs and a relatively high dropout rate in clinical settings. After proving the efficacy of prolonged exposure (PE) in Japan [Asukai, N., Saito, A., Tsuruta, N., Kishimoto, J., & Nishikawa, T. (2010). Efficacy of exposure therapy for Japanese patients with posttraumatic stress disorder due to mixed traumatic events: A randomized controlled study. Journal of Traumatic Stress, 23(6), 744-750. https://doi.org/10.1002/jts.20589], we began implementing PE in a real-world clinical setting at the Victim Support Center of Tokyo (VSCT).Objective: We aimed to investigate the effectiveness and benefit of PE for crime-induced PTSD among VSCT clients and what causes dropout from treatment.Method: Of 311 adult clients who received counselling from clinical psychologists at VSCT due to violent or physical crime victimization from April 2008 through December 2019, 100 individuals received PE and participated in this study. Their PTSD symptoms were evaluated before and after treatment using the Impact of Event Scale-Revised and the Clinician-Administered PTSD Scale for DSM-IV.Results: A total of 93 participants completed PE and seven dropped out after six sessions or less. The completers group improved in PTSD symptoms with significant score differences between pre- and post-treatment in IES-R and CAPS-IV. Participants' symptoms did not exacerbate after treatment. Forty of 49 completers who left their workplace or college/school after victimization returned to work or study shortly after treatment. Compared to the completers, all dropout participants were women and younger. The majority were rape survivors, with significantly shorter intervals between victimization and treatment. The reasons for dropout were difficulty scheduling treatment between work/study schedules and manifestation of bipolar disorder or physical illness.Conclusions: PE can be implemented with significant effectiveness and a low dropout rate in a real-world clinical setting if advantages in the system and policies, local organizational context, fidelity support and patient engagement are fortified.

We conducted prolonged exposure (PE) with a low dropout rate for crime-induced PTSD in a non-Western real-world practice setting.Patient outcomes and low dropout rate of PE for PTSD in this study may be due to advantages in the following areas: system and policies, local organizational context, fidelity support and patient engagement.When introducing PE for PTSD, it is important to confirm that patients can be reasonably engaged with PE, and to carefully assess the status of other psychiatric and physical illnesses.

Premature termination of inpatient eating disorder treatment: Does timing matter?

BACKGROUND: Premature termination of treatment is a serious problem in the treatment of eating disorders. Prior research attempting to differentiate patients who are able to complete treatment from those who terminate early has yielded mixed results. One proposed explanation for this is a failure to examine the time course of treatment termination. This study was designed to explore associations between baseline patient characteristics and timing of treatment termination. METHODS: Participants were 124 eating disorder patients admitted voluntarily to the inpatient program at Toronto General Hospital between 2009 and 2015. At admission, all patients completed measures of eating disorder symptoms, eating disorder cognitions, depressive symptoms and emotional dysregulation. Body weight was measured weekly. Data analyses were completed using one-way ANOVAs and Chi Square tests. RESULTS: Results showed significant associations between timing of treatment termination and eating disorder diagnosis, severity of eating disorder cognitions and severity of depressive symptoms. Post-hoc analyses revealed that patients who left treatment early had more severe depressive symptoms, eating disorder cognitions related to eating and difficulties engaging in goal directed behaviors when emotionally dysregulated. CONCLUSIONS: Patients who terminated inpatient treatment early in their admissions differ from patients who terminated later and those who completed treatment. These differences have potential clinical implications for the clinical management of patients with severe eating disorders requiring inpatient admission. Trial registration This paper is not associated with a clinical trial.

Patients being unable to complete inpatient treatment is serious problem in the treatment of eating disorders. Prior research attempting to identify differences between patients who can complete treatment and those who cannot has had mixed results. This study was designed to explore whether patients who leave treatment at different times differ from each other. To do this we compared eating disorder symptoms, eating disorder thoughts, depressive symptoms and emotional regulation symptoms of patients who left treatment early (0­4 weeks), later (after 4 weeks but before completion) and those who completed treatment. Results showed that patients who left treatment early reported the most severe eating disorder beliefs and depressive symptoms. They also had the most difficulties engaging in goal directed behaviours when experiencing intense emotions. They were not found to have differences in body weights or rates of eating disorder behaviors (i.e. self-induced vomiting). These results suggest that patients who leave treatment early are the most unwell and may benefit from learning emotional regulation skills prior to, or early in, treatment.

Profiles of patients with substance-related disorders who dropped out or not from addiction treatment.

This longitudinal study identified profiles of patients with substance-related disorders (SRD) who did or did not drop out of specialized addiction treatment, integrating various patterns of outpatient service use. Medical administrative databases of Quebec (Canada) were used to investigate a cohort of 16,179 patients with SRD who received specialized addiction treatment. Latent class analysis identified patient profiles, based on multi-year outpatient service use. Four patient profiles related to treatment dropout were identified: patients who did not drop out and were low service users (Profile 1); patients who did not drop out and were high service users (Profile 2); patients who dropped out and were low service users (Profile 3); patients who dropped out and were high service users (Profile 4). Profile 1 had the best health and social conditions, while Profile 4 had the worst. The risks of being frequent emergency department users, being hospitalized or dying were highest in Profile 4, followed by Profiles 3, 2 and 1. Assertive treatment programs may be suited to Profile 4 and intensive case management programs to Profile 3. Collaborative care with higher psychosocial interventions and regularity of care may be extended to Profile 2 and interventions integrating motivational treatment to Profile 1.

Eating Disorder Treatment Dropout: What Factors Influence Access to Specialty Care in an Underresourced Appalachian Region?

Appalachia is uniquely impacted by healthcare disparities. Outpatient dropout rates remain a significant barrier for individuals necessitating specialty eating disorder (ED) treatment. We explored factors impacting patient continuation in specialty outpatient care for EDs. Participants (N=138; 89.9% female) were patients with EDs attending specialty outpatient treatment in a geographically isolated, under-resourced Appalachian community. Patient dropout rate was 26.8%. Dropout rates did not significantly differ across any sociocultural factors except patient age and BMI; patients who discontinued were older and had higher BMIs at intake, perhaps due to longer duration of illness or treatment-related misconceptions. Implications and future directions are discussed.

Predictors of psychotherapy dropout in patients with borderline personality disorder: A systematic review.

INTRODUCTION: Borderline personality disorder (BPD) is a highly debilitating psychiatric condition. Despite the expansion of new BPD specific forms of psychotherapy in the last few decades, high dropout rates have been reported in these treatments. Treatment discontinuation is associated with poor patient outcomes, inefficient resource utilization and the demoralization of healthcare providers. METHODS: In order to identify predictors of psychotherapy dropout among patients with BPD, a systematic search of Medline, the Cochrane Library, PsycInfo and PsycArticles was conducted. Studies included were randomized-controlled trials in which patients diagnosed with BPD were exposed to a therapeutic intervention consisted of an evidence-based psychotherapy. The quality of evidence in the studies was assessed through the use of revised Cochrane risk of bias tool. RESULTS: Six articles, incorporating four types of psychotherapy programmes, were included. Overall, the studies present low risk of attrition and reporting bias and unclear risk of selection, performance and detection bias. Patients with weaker therapeutic alliance scores and higher hostility presented with higher dropout rates. In contrast, better mindfulness skills and greater performance in specific neuropsychological domains, such as memory and executive control, were identified as predictive of lower risk of dropout. Sociodemographic variables and treatment history did not influence treatment retention. CONCLUSIONS: Factors that influence discontinuation should be taken into consideration in future treatment programmes, in an effort to optimize retention. Qualitative assessments of patients' reasons for dropping out may also help guide adjustments.

Dropout rates and reasons for dropout among patients receiving clozapine.

Background and Aim: The present study aimed to assess the treatment dropout rates, reasons for treatment dropout, and clozapine discontinuation rate among patients attending a tertiary care center in North India. Materials and Methods: Clozapine data bank was used to identify patients on clozapine, and their treatment records were reviewed for the period Jan 2020-March 2020. Patients who did not follow-up at least once in the last 6 months were considered to have dropped out and were contacted telephonically to understand the reasons for dropout. Treatment records of those following up regularly were reviewed to check if clozapine was discontinued and if so, the reason for the same was evaluated. Results: Out of 671 patients on clozapine, 495 (73.8%) were still on regular follow-up and the remaining 176 (26.2%) had dropped out of treatment. Out of the 176 patients who had dropped out of treatment, 84 could be contacted. Common reasons for dropout were long distance from the hospital (n = 27), long waiting time for consultation (n = 8), no benefit with treatment (n = 17), side effects with medication (n = 10), moving away to another place (n = 6), refusal by the patient to follow-up (n = 7), patient improved and so did not feel the need to continue treatment (n = 7), and other reasons (n = 37). Conclusion: About one-fourth of patients who had started treatment with clozapine dropped out from the treatment. The most common reasons for dropout from treatment included long distance from the hospital and no benefit from treatment.

Real-life outcomes for oral disease-modifying treatments of relapsing-remitting multiple sclerosis patients: Adherence and adverse event profiles from Marmara University.

BACKGROUND: Disease-modifying treatments (DMT) are used to prevent future relapses and disability. High long-term adherence to treatment is important to achieve disease control. This study aims to investigate and compare adherence, adverse event (AE) profiles, and frequencies, main reasons for treatment discontinuation under Teriflunomide (TERI), Dimethyl Fumarate (DMF), and Fingolimod (FNG) for relapsing-remitting MS (RRMS) patients. This study is designed to explore patient-reported experiences in real-life settings. METHODS: Patients who were older than 18 years with a definite diagnosis of RRMS and no history of stem-cell transplantation were included. Outpatient clinic data files at the Neurology Department of Marmara University from June 2012 to June 2019 were examined retrospectively. RESULTS: One hundred and ninety MS patients were enrolled. 118 FNG, 51 DMF, 44 TERI treatment cycles were recorded. Time sincedisease onset, time since diagnosis, and treatment duration were significantly longer for FNG (p = 0.012, p = 0.004, p < 0.001). 72.8% of all the treatment cycles were continued. There was no significant difference in treatment continuity between the 3 DMT groups. The most common reasons for treatment discontinuation in order of frequency were adverse events, the progression of the disease, and the persistence of relapses. No significant difference was found for treatment discontinuation reasons. 32% of the patients reported at least one AE. 28% FNG, 49 % DMF, and 27.3% TERI using patients reported AEs. AEs were much more frequently reported for DMF (p = 0.015). The most common adverse events for each DMT were alopecia (n = 6, 13.6%) for TERI, flushing for DMF (n = 20, 39.2%), and persistent lymphopenia for FNG (n = 9, 7.6%). No severe or life-threatening AE was reported for DMF, one patient experienced pancreatitis under TERI, and 11 (9.3%) patients using FNG had to stop treatment due to serious or life-threatening AEs including cardiac adverse events, opportunistic infections, and dysplasia. DISCUSSION: Overall treatment discontinuation because of AEs is as low as 10.3% in this study. However, AEs are still the main reason for treatment drop-out.

Predictors of dropout from treatment among patients using specialized addiction treatment centers.

OBJECTIVES: This study investigated the use of outpatient care, and sociodemographic and clinical characteristics of patients with substance-related disorders (SRD) to predict treatment dropout from specialized addiction treatment centers. The study also explored risks of adverse outcomes, frequent emergency department (ED) use (3+ visits/year), and death, associated with treatment dropout within the subsequent 12 months. METHODS: The study examined a cohort of 16,179 patients who completed their last treatment episode for SRD between 2012-13 and 2014-15 (financial years: April 1 to March 31) in 14 specialized addiction treatment centers using Quebec (Canada) health administrative databases. We used multivariable logistic regressions to measure risk of treatment dropout (1996-96 to 2014-15), while we used survival analysis controlling for sex and age to assess the odds of frequent ED use and death in 2015-16. RESULTS: Of the 55 % of patients reporting dropout from SRD treatment over the 3-year period, 17 % were frequent ED users, and 1 % died in the subsequent 12 months. Patients residing in the most socially deprived areas, having polysubstance-related disorders or personality disorders, and having previously dropped out from specialized addiction treatment centers had increased odds of current treatment dropout. Older patients, those with a history of homelessness, past SRD treatment, or more concurrent outpatient care outside specialized addiction treatment centers had decreased odds of treatment dropout. Patients who dropped out were subsequently at higher risk of frequent ED use and death. CONCLUSIONS: This study highlighted that patients with more severe problems and previous dropout may need more sustained and adequate help to prevent subsequent treatment dropout. Specialized addiction treatment centers may consider enhancing their follow-up care of patients over a longer duration and better integrating their treatment with other outpatient care resources to meet the multiple needs of the more vulnerable patients using their services.

Exploring factors jointly associated with recurrent relapse and dropout of methadone maintenance treatment clients in Guangdong, China: A retrospective cohort study.

BACKGROUND: Clients receiving methadone maintenance treatment (MMT) may experience multiple relapses, which may lead to dropout. However, previous studies mostly only explored the influencing factors of relapse or dropout separately. In this study, we investigated the influencing factors jointly associated with both recurrent relapse and dropout. METHODS: This study was conducted in 16 MMT clinics in Guangdong, China. Data on the clients' demographic characteristics; drug-related behavior; HIV, HCV, and urine morphine test results; and daily methadone doses were collected. The outcomes were time to recurrent relapse and time to dropout. A joint frailty model was used to explore factors jointly associated with recurrent relapse and dropout. The hazard ratios (HRs) of the covariates in the multivariable model were adjusted, with HR > 1 indicating a faster time to recurrent relapse and dropout. RESULTS: Among 1539 clients, 39.5% had ≥ 2 relapse events, and 90.8% of the clients dropped out. A high attendance rate was protective for recurrent relapse (HR50-80%=0.63, 95% CI: 0.51, 0.79; HR>80%=0.35, 95% CI: 0.28, 0.44) and dropout (HR50-80%=0.56, 95% CI: 0.47, 0.68; HR>80%=0.27, 95% CI: 0.23, 0.33). Being married (HR=0.80, 95% CI: 0.67, 0.96), having a fair relationship with family (HR=0.79, 95% CI: 0.67, 0.93) and drug injection (HR=0.80, 95% CI: 0.67, 0.96) were also protective for recurrent relapse. Female (HR=0.64, 95% CI: 0.50, 0.82) and a high methadone dose (≥60 ml/day; HR=0.79, 95% CI: 0.65, 0.96) were protective for dropout, and a longer traveling time to the clinic (>60 min; HR=1.59, 95% CI: 1.20, 2.10) was associated with an increased risk of dropout. CONCLUSIONS: It is common for clients to experience recurrent relapse and dropout. The findings suggest that MMT clinics should provide holistic interventions and appropriate methadone doses for clients to improve treatment compliance.

Treatment engagement in first-episode schizophrenia: Associations between intrinsic motivation and attendance during cognitive training and an aerobic exercise program.

Systematic cognitive training and aerobic exercise programs have emerged as promising interventions to improve cognitive deficits in first-episode schizophrenia, with successful outcomes closely linked with greater treatment engagement (e.g., higher attendance and homework completion rates). Unfortunately, treatment disengagement from these services remains a persistent issue. Intrinsic motivation, or the willingness to exert effort because a task is inherently interesting or meaningful, has emerged as a promising malleable personal factor to enhance treatment engagement. This study investigated whether early task-specific intrinsic motivation and its domains (e.g., interest, perceived competence, and value) predicted treatment engagement within the context of intensive cognitive training and aerobic exercise interventions over a 6-month period. Thirty-nine participants with first-episode schizophrenia were administered baseline measures of task-specific intrinsic motivation inventories, one for cognitive training and one for exercise, and completed a 6-month randomized clinical trial comparing a neuroplasticity-based cognitive training plus aerobic exercise program against the same cognitive training alone. Results indicated that higher baseline scores of intrinsic motivation for cognitive training, specifically early perceptions of task interest and value, were predictive of greater cognitive training and exercise group attendance. Scores for exercise-specific intrinsic motivation were generally unrelated to indices of exercise participation, with the exception that the gain over time in perceived choice for exercise was linked with greater exercise homework completion and a similar directional tendency for greater in-clinic exercise attendance. This study provides support for monitoring and enhancing motivation early during service delivery to maximize engagement and the likelihood of successful treatment outcomes.

Experiences when implementing enhanced cognitive behavioral therapy as a standard treatment for anorexia nervosa in outpatients at a public specialized eating-disorder treatment unit.

BACKGROUND: Enhanced cognitive behavioral therapy (CBT-E) is a promising treatment option for outpatients with anorexia nervosa (AN). We aimed to determine the effectiveness of CBT-E as a standard treatment for adult outpatients with AN from the specialized eating-disorder unit of a public hospital with responsibilities to their catchment area. METHODS: This study had an open, longitudinal design. Thirty three (of planned 100) outpatients aged > 16 years suffering from AN were included to receive 40 sessions of CBT-E. Eating-disorder psychopathology and body mass index (BMI) were assessed before and after treatment, while comorbid psychiatric symptoms and trauma experiences were evaluated at the baseline, and therapeutic alliance was assessed after 4 weeks of treatment. RESULTS: A high proportion (69%) of patients dropped out of the treatment. Patient recovery was considered when they reached BMI > 18.5 and Eating Disorder Examination Questionnaire (EDE-Q) score < 2.5, and 27% of all patients recovered. CONCLUSIONS: Patients who completed the treatment had mostly satisfactory outcomes. Considering the high dropout rate, it is necessary to improve the strategies for engaging patients in therapy. Several aspects of CBT-E as a standard treatment are discussed regarding the high dropout rate. Trial registration ClinicalTrials.gov. Identifier: NCT02745067. Registered: April 20, 2016. https://clinicaltrials.gov/ct2/showNCT02745067.

Anorexia nervosa (AN) is difficult to treat, and no specific treatment approach has been demonstrated to be superior for adult outpatients. However, outcome data indicate that enhanced cognitive behavioral therapy (CBT-E) is a viable and promising treatment option for adults with AN, and its efficacy has been indicated in cohort studies and randomized controlled trials. The present study aimed to determine the effectiveness of CBT-E as a standard treatment for adult outpatients with AN from the specialized eating-disorder unit of a public hospital with responsibilities to their catchment area. Outpatient CBT-E was administered to 33 patients in a course of 40 sessions. Although 27% of the included patients had satisfactory treatment outcomes (healthy weights and reduced eating-disorder symptoms), more than two-thirds of all patients terminated treatment early. Several aspects of CBT-E as a standard treatment are discussed regarding this high dropout rate.

Dropout from treatment for mental disorders in six countries of the Americas: A regional report from the World Mental Health Surveys.

OBJECTIVE: To estimate structural and attitudinal reasons for premature discontinuation of mental health treatment, socio-demographic and clinical correlates of treatment dropout due to these reasons, and to test country differences from the overall effect across the region of the Americas. METHODS: World Health Organization-World Mental Health (WMH) surveys were carried out in six countries in the Americas: Argentina, Brazil, Colombia, Mexico, Peru and USA. Among the 1991 participants who met diagnostic criteria (measured with the Composite International Diagnostic Interview (WMHCIDI)) for a mental disorder and were in treatment in the prior 12-months, the 236 (12.2%) who dropped out of treatment before the professional recommended were included. FINDINGS: In all countries, individuals more frequently reported attitudinal (79.2%) rather than structural reasons (30.7%) for dropout. Disorder severity was associated with structural reasons; those with severe disorder (versus mild disorder) had 3.4 (95%CI=1.1-11.1) times the odds of reporting a structural reason. Regarding attitudinal reasons, those with lower income (versus higher income) were less likely to discontinue treatment because of getting better (OR=0.4; 95%CI= 0.2-0.9). Country specific variations were found. LIMITATIONS: Not all countries, or the poorest, in the region were included. Some estimations couldn´t be calculated due to cell size. Causality cannot be assumed. CONCLUSION: Clinicians should in the first sessions address attitudinal factors that may lead to premature termination. Public policies need to consider distribution of services to increase convenience. A more rational use of resources would be to offer brief therapies to individuals most likely to drop out of treatment prematurely.

Factors Causing Dropout From Treatment During the Ponseti Method of Clubfoot Management: The Caregivers' Perspective.

A retrospective comparative study was conducted, aiming to identify factors associated with dropout from clubfoot treatment by Ponseti method in low- and middle-income countries. A prospectively gathered database of patients who received treatment at a high-volume urban clubfoot clinic over 6 years was queried for dropouts. A "dropout" was identified as any child that had not had a visit within 3 weeks of casting, 4 weeks of tenotomy or 6 months of brace follow-up. The second part of the study was a telephonic interview with caregivers of the identified dropouts to ascertain their reasons for discontinuing treatment. Of the 965 patients treated during the study period, there were 155 (16.06%) dropouts-137 (88.38%) during bracing phase and 18 (11.62%) during casting phase. Age at presentation was significantly higher among the dropouts as compared to those who did not dropout (median 9.5 and 7 months for casting and bracing dropouts respectively versus 3.5 months for regular follow-ups, p < .001). No significant correlation was found between patient dropout and sex (p = .061), or laterality (p = .071). Thirty-seven caregivers (23.8%) could be contacted telephonically; including 6 casting and 31 bracing dropouts. The most commonly cited reason for dropout from treatment was lack of family support (75.7%), followed by distance to the clinic (59.5%) and unavailability of transport (54.1%). Sixteen caregivers (43.2%) dropped out on account of migration to another town/state. Maintenance of a meticulous registry with regular update of caregivers' contact details, and interventions to mitigate the identified hurdles can help in reducing treatment dropouts.

Gender Differences Between Domestic Violent Men and Women: Criminogenic Risk Factors and Their Association With Treatment Dropout.

Although many studies have concluded that men and women engage in domestic violence at equal levels, existing studies have hardly focused on gender specific risk factors for domestic violence perpetration. Therefore, this study aimed to examine gender differences in criminogenic risk factors between Dutch male and female forensic outpatients who were referred to forensic treatment for domestic violence. Clinical structured assessments of criminogenic risk factors were retrieved for 366 male and 87 female outpatients. Gender differences were not only found in the prevalence and interrelatedness of criminogenic risk factors, but also in associations between criminogenic risk factors and treatment dropout. In men, risk factors related to the criminal history, substance abuse, and criminal attitudes were more prevalent than in women, whereas risk factors related to education/work, finances, and the living environment were more prevalent in women. Further, having criminal friends, having a criminal history, and drug abuse were associated with treatment dropout in men, whereas a problematic relationship with family members, housing instability, a lack of personal support, and unemployment were associated with treatment dropout in women. Finally, network analyses revealed gender differences in risk factor interrelatedness. The results provide important insights into gender specific differences in criminogenic risk factors for domestic violence, which support clinical professionals in tailoring treatment to the specific needs of male and female perpetrators of domestic violence.

Predicting and preventing dropout in research, assessment and treatment with refugees.

Refugees and asylum seekers are exposed to multiple burdensome experiences and suffer from ongoing post-migration stressors that are known to affect the physical and mental health. In psychological treatment offered to refugees and asylum seekers, dropout is an important challenge. The current practice-oriented review aims to provide for the first time knowledge on the prevalence, prediction and prevention of dropout in psychological treatment for refugees and asylum seekers. Due to the limited empirical evidence for this specific population, we synthesized refugee-specific research but also reviewed the existing evidence on dropout from treatment in general and specifically discuss how the findings can be adapted to refugee populations. The review integrates literature from online databases, grey literature, hand search and expert contacts. Prevalence rates of dropout from psychological treatment in Western samples are reported at about 20%. For refugees and asylum seekers, evidence from single efficacy trials showed considerable variability in dropout rates (0%-64.7%). Further, for refugees and asylum seekers, specific sociodemographic variables, high initial impairment, deviating expectations and perceptions of mental health and psychological treatment, as well as external barriers seem to be important predictors for dropout. To prevent dropout, it is important to develop and promote cultural competencies, adapt the treatment to refugee-specific needs and focus on role induction, preparation for treatment, fostering the therapeutic alliance and strengthening hope. Future specific research on dropout in treatment offered to refugees and asylum seekers is needed.

Abandono de psicoterapia psicanalítica por adolescentes: uma revisão narrativa / Adolescent dropout from psychoanalytical psychotherapy: a narrative review / Abandon de la psychothérapie psychanalytique par les adolescents: une revue narrative / Abandono de la psicoterapia psicoanalítica por adolescentes: una revisión narrativa

Resumo Fenômeno frequente, embora pouco estudado, o abandono da psicoterapia por parte de adolescentes é preocupante, visto que uma expressiva parcela deles possui problemas de saúde mental. Nesse sentido, esta revisão narrativa tem como objetivo compreender por que os jovens abandonam a psicoterapia psicanalítica. Características dos adolescentes têm sido relacionadas ao abandono, como idade e gênero, e variáveis clínicas, como comportamento antissocial e delinquente, embora ainda não haja consenso. Atributos do processo terapêutico, como a qualidade da aliança terapêutica e variáveis do terapeuta, também estão associadas à manutenção ou não da psicoterapia. Concluiu-se que a literatura progrediu no entendimento dos motivos que levam os adolescentes a interromperem os tratamentos psicanalíticos, com ênfase para fatores clínicos e aspectos do processo terapêutico. No entanto, mais estudos são necessários para o avanço na compreensão e prevenção do fenômeno.

Abstract The frequent phenomenon, although little explored, of adolescent dropout from psychotherapy is a worrying data, as a significant portion of them have mental health issues. As such, this narrative review based on scientific articles and books seeks to understand this phenomenon. Adolescent's characteristics such as age, gender and other clinical variables like antisocial and delinquent behavior have been associated with dropout, but there is still no consensus. Attributes of the therapeutic process, such as the quality of the therapeutic alliance and therapist variables, are also associated with whether or not psychotherapy is maintained. In conclusion, literature is progressing in its understanding of why adolescents dropout from psychoanalytic treatment, emphasizing clinical factors and aspects of the therapeutic process. However, more studies are necessary to advance knowledge and prevention of this phenomenon.

Résumé Le phénomène fréquent, bien que peu exploré, de l'abandon des psychothérapies par les adolescents est une donnée sont préoccupante, dans la mesure où une partie importante d'entre eux présente des problèmes de santé mentale. Ainsi, cette revue narrative basée sur des articles et ouvrages scientifiques cherche à comprendre ce phénomène. Les caractéristiques de l'adolescent telles que l'âge, le sexe et d'autres variables cliniques comme le comportement antisocial et délinquant ont été associées à l'abandon, mais il n'y a toujours pas de consensus. Les attributs du processus thérapeutique, tels que la qualité de l'alliance thérapeutique et les variables du thérapeute, sont également associés au maintien ou non de la psychothérapie. En conclusion, la littérature progresse dans sa compréhension des raisons pour lesquelles les adolescents abandonnent le traitement psychanalytique, en mettant l'accent sur les facteurs cliniques et les aspects du processus thérapeutique. Cependant, d'autres études sont nécessaires pour faire progresser la connaissance et la prévention de ce phénomène.

Resumen El frecuente y poco estudiado abandono de la psicoterapia por los adolescentes es preocupante, ya que parte importante de ellos tiene problemas de salud mental. En este contexto, esta revisión narrativa tuvo como objetivo comprender las razones de esta práctica. Las características de los adolescentes que se han relacionado con el abandono fueron la edad, el sexo y variables clínicas como la conducta antisocial y delictiva, aunque aún no existe consenso. Las características del proceso terapéutico como la calidad de la alianza terapéutica y las variables del terapeuta también se han asociado al mantenimiento o no de la psicoterapia. Se concluyó que la literatura avanza en la comprensión de por qué los adolescentes interrumpen los tratamientos psicoanalíticos, con énfasis en los factores clínicos y aspectos del proceso terapéutico. Se necesitan más estudios para avanzar en la comprensión y prevención del fenómeno.

Acompanhamento dos bebês de alto risco em serviços de saúde: compromisso a favor da vida / Seguimiento del bebé de alto riesgo en los servicios de salud: un compromiso de por vida / Follow-up of high risk babies in health services: a commitment for life

Objetivo: identificar os motivos que levam as mães de bebês de alto risco a abandonarem o acompanhamento no Ambulatório de Alto Risco, ao longo do primeiro ano de vida. Método: estudo descritivo e exploratório, de natureza qualitativa realizado com 16 mães de bebês que foram acompanhados no Ambulatório de Alto Risco vinculado ao Programa Rede Mãe Paranaense. A coleta de dados ocorreu entre os meses de agosto e setembro de 2020, mediante entrevistas semiestruturadas e submetidas à análise de conteúdo, modalidade temática. Resultados: Emergiram duas categorias: Abandono do acompanhamento infantil de alto risco: desconhecimento atrelado a falta de apoio social; Ansiedade frente ao desconhecido: vivência das mães após o nascimento. Conclusão: os motivos referentes aos aspectos maternos, familiares, sociais e características dos serviços de saúde podem influenciar no abandono do acompanhamento infantil.(AU)

Objective: to identify the reasons that lead mothers of high-risk babies to abandon follow-up at the High-Risk Outpatient Clinic, throughout the first year of life. Method: descriptive and exploratory study, qualitative in nature, conducted with 16 mothers of babies who were followed at the High Risk Outpatient Clinic linked to the Rede Mãe Paranaense Program. Data collection took place between August and September 2020, through semi-structured interviews and submitted to content analysis, thematic modality. Results: Two categories emerged: Abandonment of high-risk child monitoring: lack of knowledge linked to lack of social support; Anxiety in the face of the unknown: mothers' experience after birth. Conclusion: the reasons related to maternal, family, social aspects and characteristics of health services can influence the abandonment of child care.(AU)

Objetivo: identificar los motivos que llevan a las madres de bebés de alto riesgo a abandonar el seguimiento en la Clínica Ambulatoria de Alto Riesgo, a lo largo del primer año de vida. Método: estudio descriptivo y exploratorio, de carácter cualitativo, realizado con 16 madres de bebés que fueron seguidos en la Clínica de Alto Riesgo vinculada al Programa Rede Mãe Paranaense. La recolección de datos se realizó entre agosto y septiembre de 2020, a través de entrevistas semiestructuradas y sometidas a análisis de contenido, modalidad temática. Resultados: Surgieron dos categorías: Abandono del monitoreo infantil de alto riesgo: desconocimiento vinculado a falta de apoyo social; Ansiedad ante lo desconocido: la experiencia de las madres después del nacimiento. Conclusión: las razones relacionadas con aspectos maternos, familiares, sociales y características de los servicios de salud pueden influir en el abandono del cuidado infantil.(AU)

Factors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records.

PURPOSE: To describe attrition patterns of opioid use disorder (OUD) patients treated with buprenorphine (BUP) and to assess how clinical, sociodemographic, or BUP medication dosing features are associated with attrition. PATIENTS AND METHODS: Electronic health records of adults (16+ year-olds) with OUD treated with BUP from 23 different substance use or mental health care programs across 11 US states were examined for one year following BUP initiation in inpatient (IP), intensive outpatient (IOP), or outpatient (OP) settings. Treatment attrition was declared at >37 days following the last recorded visit. Survival analyses and predictive modelling were used. RESULTS: Retention was consistently 2-3 times higher following BUP initiation in OP (n = 2409) than in IP/IOP (n = 2749) settings after 2 (50% vs 25%), 6 (27% vs 9%) and 12 months (14% vs 4%). Retention was higher for females, whites (vs blacks), and those with less severe OUD, better global function, or not using non-psychotropic medications. Comorbid substance use, other psychiatric disorders, and the number of psychotropic medications were variously related to retention depending on the setting in which BUP was initiated. Predictive modelling revealed that a higher global assessment of functioning and a smaller OUD severity based on the Clinical Global Impression - Severity led to longer retentions, a higher initial BUP dose led to higher retention in a few cases, an OP setting of BUP initiation led to longer retentions, and a lower total number of psychotropic and non-psychotropic medications led to longer retentions. These were the most important parameters in the model, which identified 75.2% of patients who left BUP treatment within three months post-initiation, with a precision of 90.5%. CONCLUSION: Of all the OUD patients who began BUP, 50-75% left treatment within three months, and most could be accurately identified. This could facilitate patient-centered management to better retain OUD patients in BUP treatment.

A randomized clinical trial of in-person vs. home-based telemedicine delivery of Prolonged Exposure for PTSD in military sexual trauma survivors.

Posttraumatic stress disorder (PTSD) is common in women who experienced Military Sexual Trauma (MST). Despite Veterans Affairs Medical Center-wide screening and tailored MST services, substantial barriers to care exist, and about 50 % of those who start evidence-based treatment for PTSD drop out prematurely. Home-based telemedicine (HBT) may reduce logistical and stigma related barriers to mental health care, thereby reducing dropout. The current randomized clinical trial (NCT02417025) for women veterans with MST-related PTSD (N = 136) compared the efficacy of HBT delivery of Prolonged Exposure (PE) to in-person delivery of PE on measures of PTSD and depression, as well as on "PE dose" received. Hypotheses predicted that women in the HBT PE group would complete more sessions, and evince greater PTSD and depression symptom reduction compared to in-person PE. Results revealed that there were no differences in dose received or PTSD symptom reduction between in-person and HBT conditions; however, dose (i.e., more sessions) was related to reduced PTSD symptom severity. Future research should examine other factors associated with high PTSD treatment dropout among MST patients.