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Drop out from out-patient mental healthcare in the World Health Organization's World Menta Health Survey initiative

  • J. Elisabeth Wells (a1), Mark Oakley Browne (a2), Sergio Aguilar-Gaxiola (a3), Ali Al-Hamzawi (a4), Jordi Alonso (a5), Matthias C. Angermeyer (a6), Colleen Bouzan (a7), Ronny Bruffaerts (a8), Brendan Bunting (a9), José Miguel Caldas-de-Almeida (a10), Giovanni De Girolamo (a11), Ron De Graaf (a12), Silvia Florescu (a13), Akira Fukao (a14), Oye Gureje (a15), Hristo Ruskov Hinkov (a16), Chiyi Hu (a17), Irving Hwang (a7), Elie G. Karam (a18), Stanislav Kostyuchenko (a19), Viviane Kovess-Masfety (a20), Daphna Levinson (a21), Zhaorui Liu (a22), Maria Elena Medina-Mora (a23), S. Haque Nizamie (a24), José Posada-Villa (a25), Nancy A. Sampson (a7), Dan J. Stein (a26), Maria Carmen Viana (a27) and Ronald C. Kessler (a7)...

Abstract

Background

Previous community surveys of the drop out from mental health treatment have been carried out only in the USA and Canada.

Aims

To explore mental health treatment drop out in the World Health Organization World Mental Health Surveys.

Method

Representative face-to-face household surveys were conducted among adults in 24 countries. People who reported mental health treatment in the 12 months before interview (n = 8482) were asked about drop out, defined as stopping treatment before the provider wanted.

Results

Overall, drop out was 31.7%: 26.3% in high-income countries, 45.1% in upper-middle-income countries, and 37.6% in low/ lower/middle-income countries. Drop out from psychiatrists was 21.3% overall and similar across country income groups (high 20.3%, upper-middle 23.6%, low/lower-middle 23.8%) but the pattern of drop out across other sectors differed by country income group. Drop out was more likely early in treatment, particularly after the second visit.

Conclusions

Drop out needs to be reduced to ensure effective treatment.

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Copyright

Corresponding author

J. Elisabeth Wells, Department of Public Health and General Practice, university of Otago, Christchurch PO Box 4345, Christchurch 8140, New Zealand. Email: elisabeth.wells@otago.ac.nz

Footnotes

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Declaration of interest

R.C.K. has been a consultant for AstraZeneca, Analysis Group, Bristol-Myers Squibb, Cerner-Galt Associates, Eli Lilly & Company, GlaxoSmithKline, HealthCore, Health Dialog, Integrated Benefits Institute, John Snow, Kaiser Permanente, Matria, Mensante, Merck & Co., Ortho-McNeil Janssen Scientific Affairs, Pfizer, Primary Care Network, Research Triangle Institute, Sanofi-Aventis Groupe, Shire US, SRA International, Takeda Global Research & Development, Transcept Pharmaceuticals, and Wyeth-Ayerst; has served on advisory boards for Appliance Computing II, Eli Lilly & Company, Mindsite, Ortho-McNeil Janssen Scientific Affairs, Plus One Health Management and Wyeth-Ayerst; and has had research support for his epidemiological studies from Analysis Group, Bristol-Myers Squibb, Eli Lilly & Company, EPI-Q, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho-McNeil Janssen Scientific Affairs, Pfizer, Sanofi-Aventis Groupe and Shire US. D.J.S. has received research grants and/or consultancy honoraria from Abbott, AstraZeneca, Eli-Lilly, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, Takeda, Tikvah and Wyeth.

Footnotes

References

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1 Kessler, RC, Haro, JM, Heeringa, SG, Pennell, B-E, Üstün, TB. The World Health Organization World Mental Health Survey Initiative. Epidemiol Psichiatr Soc 2006; 15: 161–6.
2 Wang, PS, Aguilar-Gaxiola, S, Alonso, J, Angermeyer, MC, Borges, G, Bromet, EJ, et al Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO World Mental Health Surveys. Lancet 2007; 370: 841–50.
3 Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, et al Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291: 2581–90.
4 Wang, PS, Angermeyer, M, Borges, G, Bruffaerts, R, Chiu, WT, de Girolamo G, et al Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 2007; 6: 177–85.
5 Wang, J. Mental health treatment dropout and its correlates in a general population. Med Care 2007; 45: 224–9.
6 Wang, PS, Gilman, SE, Guardino, M, Christiana, JM, Morselli, PL, Mickelson, K, et al Initiation of and adherence to treatment for mental disorders: examination of patient advocate group members in 11 countries. Med Care 2000; 38: 926–36.
7 Edlund, MJ, Wang, PS, Berglund, PA, Katz, SJ, Lin, E, Kessler, RC. Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. Am J Psychiatry 2002; 159: 845–51.
8 Olfson, M, Mojtabai, R, Sampson, NA, Hwang, I, Druss, B, Wang, PS, et al Dropout from outpatient mental health care in the United States. Psychiatr Serv 2009; 60: 898907.
9 Kessler, RC, Üstün, B. The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004; 13: 93121.
10 Andersen, RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995; 36: 110.
11 Kessler, RC,Üstün, TB. The WHO World Mental Health Surveys. Global Perspectives on the Epidemiology of Mental Disorders. Cambridge University Press, 2008.
12 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). APA, 1994.
13 Kessler, RC, Angermeyer, M, Anthony, JC, de Graaf, R, Demyttenaere, K, Gasquet, I, et al Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 2007; 6: 168–76.
14 Westmacott, R, Hunsley, J. Reasons for terminating psychotherapy: a general population study. J Clin Psychol 2010; 66: 965–77.
15 World Health Organization. Project Atlas: Resources for Mental Health. WHO, 2011 (http://www.who.int/mental_health/evidence/atlas/en/).
16 Rhodes, AE, Fung, K. Self-reported use of mental health services versus administrative records: care to recall? Int J Methods Psychiatr Res 2004; 13: 165–75.
17 Wierzbicki, M, Pekarik, G. A meta-analysis of psychotherapy dropout. Prof Psychol Res Prac 1993; 24: 190–5.
18 Beynon, CM, McMinn, AM, Marr, AJ. Factors predicting drop out from, and retention in, specialist drug treatment services: a case control study in the North West of England. BMC Public Health 2008; 8: 149–59.
19 Mitchell, AJ, Selmes, T. A comparative survey of missed initial and follow-up appointments to psychiatric specialties in the United Kingdom. Psychiatr Serv 2007; 58: 868–71.
20 Reneses, B, Munoz, E, Lopez-Ibor, JJ. Factors predicting drop-out in community mental health centres. World Psychiatry 2009; 8: 173–7.
21 Barrett, MS, Chua, WJ, Crits-Christoph, P, Gibbons, MB, Thompson, D. Early withdrawal from mental health treatment: implications for psychotherapy practice. Psychotherapy 2008; 45: 247–67.
22 Rossi, A, Amaddeo, F, Bisoffi, G, Ruggeri, M, Thornicroft, G, Tansella, M. Dropping out of care: inappropriate terminations of contact with community-based psychiatric services. Br J Psychiatry 2002; 181: 331–8.
23 Ruggeri, M, Salvi, G, Bonetto, C, Lasalvia, A, Allevi, L, Parabiaghi, A, et al Outcome of patients dropping out from community-based mental health care: a 6-year multiwave follow-up study. Acta Psychiatr Scand Suppl 2007; 437: 4252.
24 Westmacott, R, Hunsley, J, Best, M, Rumstein-McKean, O, Schindler, D. Client and therapist views of contextual factors related to termination from psychotherapy: a comparison between unilateral and mutual terminators. Psychother Res 2010; 20: 423–35.
25 Johansson, H, Eklund, M. Helping alliance and early dropout from psychiatric out-patient care. Soc Psychiatry Psychiatr Epid 2006; 41: 140–7.
26 Ogrodniczuk, JS, Joyce, AS, Piper, WE. Strategies for reducing patient-initiated premature termination of psychotherapy. Harv Rev Psychiatry 2005; 13: 5770.
27 Miranda, J, Azocar, F, Organista, KC, Dwyer, E, Araene, P. Treatment of depression among impoverished primary care patients from ethnic minority groups. Psychiatr Serv 2003; 54: 219–25.
28 Kitcheman, J, Adams, CE, Pervaiz, A, Kader, I, Mohandas, D, Brookes, G. Does an encouraging letter encourage attendance at psychiatric out-patient clinics? The Leeds PROMPTS randomized study. Psychol Med 2008; 38: 717–23.
29 Bull, SA, Hu, XH, Lee, JY, Ming, EE, Markson, LE, Fireman, B. Discontinuation of use and switching of antidepressants: influence of patient-physician communication. JAMA 2002; 288: 1403–9.
30 Rohrer, JE, Vaughan, MS, Cadoret, RJ, Carswell, C, Patterson, A, Zwick, J. Effect of centralized intake on outcomes of substance abuse treatment. Psychiatr Serv 1996; 47: 1233–8.

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Drop out from out-patient mental healthcare in the World Health Organization's World Menta Health Survey initiative

  • J. Elisabeth Wells (a1), Mark Oakley Browne (a2), Sergio Aguilar-Gaxiola (a3), Ali Al-Hamzawi (a4), Jordi Alonso (a5), Matthias C. Angermeyer (a6), Colleen Bouzan (a7), Ronny Bruffaerts (a8), Brendan Bunting (a9), José Miguel Caldas-de-Almeida (a10), Giovanni De Girolamo (a11), Ron De Graaf (a12), Silvia Florescu (a13), Akira Fukao (a14), Oye Gureje (a15), Hristo Ruskov Hinkov (a16), Chiyi Hu (a17), Irving Hwang (a7), Elie G. Karam (a18), Stanislav Kostyuchenko (a19), Viviane Kovess-Masfety (a20), Daphna Levinson (a21), Zhaorui Liu (a22), Maria Elena Medina-Mora (a23), S. Haque Nizamie (a24), José Posada-Villa (a25), Nancy A. Sampson (a7), Dan J. Stein (a26), Maria Carmen Viana (a27) and Ronald C. Kessler (a7)...

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