Treatment dropout among veterans and their families: Quantitative and qualitative findings.

Psychotherapy non-completion rates for veterans and their families are high. This study sought to 1) measure non-completion rates of such patients at a university-based treatment center, 2) compare veteran and family member attrition rates, 3) identify dropout predictors, and 4) explore clinicians’ perspectives on treatment non-completion. Using quantitative and qualitative approaches, we analyzed demographic and clinical characteristics of 141 patients (90 military veterans; 51 family members) in a university treatment center. We defined dropout as not completing the time-limited therapy contract. Reviewing semi-structured interview data assessing clinicians’ perspectives on their patients’ dropout, three independent raters agreed on key themes, with interrater coefficient kappa range 0.74 to 1. Patient attrition was 24%, not differing significantly between veterans and family members. Diagnosis of major depression (MDD) and exposure-based therapies predicted non-completion, as did higher baseline Hamilton Depression Rating Scale (HDRS) total scores, severe depression (HDRS>20), lack of Beck Depression Inventory weekly improvement, and history of military sexual trauma. Clinicians mostly attributed non-completion to patient difficulties coping with intense emotions, especially in exposure-based therapies. Non-completion rate at this study appeared relatively low compared to other veteran-based treatment centers, if still unfortunately substantial. Patients with comorbid MDD/PTSD and exposure-based therapies carried greater non-completion risk due to the MDD component, and this should be considered in treatment planning. Ongoing discussion of dissatisfaction and patient discontinuation, in the context of a strong therapeutic alliance, might reduce non-completion in this at-risk population.

退伍军人及其家属的心理治疗未完成率很高。本研究旨在：1）测量某大学治疗中心此类患者的未完成率；2）比较退伍军人和家属的流失率；3）确定辍学（此处指治疗未完成）的预测因素；4）探究临床医生对治疗未完成的看法。 我们采用定量和定性方法，分析了某大学治疗中心141名患者（90名退伍军人；51名家属）的人口统计学和临床特征。我们将辍学定义为未完成有时间限制的治疗合同。通过回顾评估临床医生对其患者辍学看法的半结构化访谈数据，三名独立评分者就关键主题达成一致，评分者间系数卡帕值范围为0.74至1。 患者流失率为24%，退伍军人和家属之间无显著差异。重度抑郁症（MDD）的诊断和基于暴露的疗法可预测治疗未完成，较高的基线汉密尔顿抑郁评定量表（HDRS）总分、重度抑郁（HDRS>20）、贝克抑郁量表每周无改善以及军队性创伤史也可预测治疗未完成。临床医生大多将治疗未完成归因于患者难以应对强烈情绪，尤其是在基于暴露的疗法中。 与其他以退伍军人为服务对象的治疗中心相比，本研究中的未完成率似乎相对较低，但仍然很高。患有共病MDD/创伤后应激障碍（PTSD）且接受基于暴露疗法的患者由于MDD因素，未完成治疗的风险更高，在治疗计划中应考虑到这一点。在稳固的治疗联盟背景下，持续讨论不满和患者中断治疗的问题，可能会降低这一高危人群的治疗未完成率。