[Drop-out from a mental health centre after the first contact].
OBJECTIVE
Many patients drop-out from treatment after a single contact; however, characteristics have only rarely been investigated. We aimed at estimating the frequency of early drop-out and identifying possible risk factors.


METHODS
The study was performed at the Palestrina Mental Health Centre, located near Rome, Italy. The clinical charts of all first-time attenders who did not come back during a 7-year index period (2000-2006) were reviewed and information was collected on sociodemographic factors, psychiatric history, clinical presentation, and process of care.


RESULTS
During the index period, 97 of 1.001 first-time attenders dropped out after the first contact. We excluded patients with symptoms of organic (N = 9) or severe mental disorders (N = 3). Of the remaining 85 patients, 49 presented with symptoms related to life events or situations ("reactive symptoms", RS), while 36 had "non-reactive symptoms" (NRS). Eighty-five randomly selected patients with comparable conditions (psychogenic reaction; anxiety, dysthymic or somatoform disorder; ICD-9 code 300.x, 308.x, 309.x) who came back to visit were included as controls. First-only contact patients tended to present with RS more often (58% vs. 43%) than controls. Therefore, the analyses were stratified for reactivity of symptoms. Among patients with NRS, first-only contact patients tended to be younger than controls. Among patients with RS, time until the next appointment tended to be longer in first-only contact patients than in controls. No other differences were observed between first-only contact patients and controls on sociodemographic variables, source of referral, and previous treatment history.


CONCLUSIONS
The occurrence of early drop-out was relatively low. The higher prevalence of RS among first-only contact patients may suggest a greater disposition towards conflict or ambivalence in interpersonal situations. Patient-perceived service availability, in the form of shorter appointment delay, seems to promote maintenance of contact. Younger patients who tend to be at higher risk of early drop-out deserve increased clinical attention.
Palmieri
Giovanni
G
Centro di Salute Mentale, ASL RM/G Palestrina, RM.
D'Amore
Carlo
C
Cecchetti
Rita
R
Bonamoneta
Nadia
N
Gonnella
Maria Antonietta
MA
Moio
Margherita
M
Paoletti
Stefania
S
Vendetti
Stefania
S
Schiavella
Rita
R
Picardi
Angelo
A
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D010352:Patient Dropouts / Q000706:statistics & numerical data*