title: Identifying risk for attrition during treatment for depression.
abstract: BACKGROUND
  Understanding patients' ambivalence about treatment persistence may be useful in tailoring retention interventions for individual patients with major depressive disorder.
  
  
  METHODS
  Participants (n = 265) with major depressive disorder were enrolled into an 8-week trial with a selective serotonin reuptake inhibitor. At baseline and week 2, the participants were asked about their intent to return for the next visit, complete the study and continue in the study should they experience side effects or no improvement. Dropouts were defined as participants who discontinued attending clinic visits before completing the trial.
  
  
  RESULTS
  Participants who at baseline reported an uncertain/negative intent to continue if they experienced side effects or no improvement dropped out at a significantly higher rate by weeks 6 and 8. Uncertain/negative intent at week 2 predicted attrition at all following visits. Dropouts without side effects were more likely to have reported an uncertain/negative intent to attend at both baseline and week 2, while dropouts who experienced side effects were more likely to have reported an uncertain/negative intent to attend only at baseline. Positive intent to continue was associated with greater symptom improvement in both dropouts and completers despite the possibility of lack of efficacy.
  
  
  CONCLUSIONS
  Participants' pretreatment concerns about continuing antidepressant treatment in the presence of side effects signals challenges to the completion of a full 8-week acute phase treatment, even if the participant does not develop side effects. Individualized review of concerns and tailoring appropriate interventions may be necessary to reduce attrition.
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA. Diane.Warden@UTSouthwestern.edu
authors.forename: Diane
authors.initials: D
authors.lastname: Warden
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Ira M
authors.initials: IM
authors.lastname: Lesser
authors.forename: Jeff
authors.initials: J
authors.lastname: Mitchell
authors.forename: G K
authors.initials: GK
authors.lastname: Balasubramani
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Kathy
authors.initials: K
authors.lastname: Shores-Wilson
authors.forename: Diane
authors.initials: D
authors.lastname: Stegman
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001290:Attitude; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors