title: Dropouts versus completers among chronically depressed outpatients.
abstract: BACKGROUND
  Premature termination is common among patients treated for depression with either pharmacotherapy or psychotherapy. Yet little is known about factors associated with premature treatment termination among depressed patients.
  
  
  METHODS
  This study examines predictors of, time to, and reasons for dropout from the 12-week acute phase treatment of nonpsychotic adult outpatients, age 18-75, with chronic major depression who were randomly assigned to nefazadone alone (MED), cognitive behavioral analysis system of psychotherapy alone (CBASP) or both treatments (COMB).
  
  
  RESULTS
  Of 681 randomized study participants, 156 were defined as dropouts. Dropout rates were equivalent across the three treatments. Among dropouts, those in COMB remained in treatment (Mean=40 days) significantly longer than those in either MED (Mean=27 days) or CBASP (Mean=28 days). Dropouts attributed to medication side-effects were significantly lower in COMB than in MED, suggesting that the relationship with the psychotherapist may increase patient willingness to tolerate side-effects associated with antidepressant medications. Ethnic or racial minority status, younger age, lower income, and co-morbid anxiety disorders significantly predicted dropout in the full sample. Within treatments, differences between completers and dropouts in minority status and the prevalence of anxiety disorders were most pronounced in MED. Among those receiving CBASP, dropouts had significantly lower therapeutic alliance scores than completers.
  
  
  CONCLUSIONS
  The sample included only individuals with chronic depression.
  
  
  CONCLUSIONS
  Predictors of dropout included baseline patient characteristics, but not early response to treatment. Ethnic and racial minorities and those with comorbid anxiety are at higher risk of premature termination, particularly in pharmacotherapy, and may require modified treatment strategies.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5722, United States. arnow@stanford.edu
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Arnow
authors.forename: Christine
authors.initials: C
authors.lastname: Blasey
authors.forename: Rachel
authors.initials: R
authors.lastname: Manber
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Constantino
authors.forename: John C
authors.initials: JC
authors.lastname: Markowitz
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Klein
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: James H
authors.initials: JH
authors.lastname: Kocsis
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000523:psychology*; D010817:Physician-Patient Relations; D010879:Piperazines; D012307:Risk Factors; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D010879:Piperazines; D014230:Triazoles; C051752:nefazodone