title: Acute phase cognitive therapy for recurrent major depressive disorder: who drops out and how much do patient skills influence response?
abstract: OBJECTIVE
  The aims were to predict cognitive therapy (CT) noncompletion and to determine, relative to other putative predictors, the extent to which the patient skills in CT for recurrent major depressive disorder predicted response in a large, two-site trial.
  
  
  METHODS
  Among 523 outpatients aged 18e70, exposed to 12e14 weeks of CT, 21.6% dropped out. Of the 410 completers, 26.1% did not respond. To predict these outcomes, we conducted logistic regression analyses of demographics, pre-treatment illness characteristics and psychosocial measures, and midtreatment therapeutic alliance.
  
  
  RESULTS
  The 17-item Hamilton Rating Scale for Depression (HRSD17) scores at entry predicted dropout and nonresponse. Patients working for pay, of non-Hispanic white race, who were older, or had more education were significantly more likely to complete. Controlling for HRSD17, significant predictors of nonresponse included: lower scores on the Skills of Cognitive Therapy-Observer Version (SoCT-O), not working for pay, history of only two depressive episodes, greater pre-treatment social impairment. Midphase symptom reduction was a strong predictor of final outcome.
  
  
  CONCLUSIONS
  These prognostic indicators forecast which patients tend to be optimal candidates for standard CT, as well as which patients may benefit from changes in therapy, its focus, or from alternate modalities of treatment. Pending replication, the findings underscore the importance of promoting patients’ understanding and use of CT skills, as well as reducing depressive symptoms early. Future research may determine the extent to which these findings generalize to other therapies, providers who vary in competency, and patients with other depressive subtypes or disorders.
authors.affiliation: Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9149, United States. Robin.Jarrett@UTSouthwestern.edu
authors.forename: Robin B
authors.initials: RB
authors.lastname: Jarrett
authors.forename: Abu
authors.initials: A
authors.lastname: Minhajuddin
authors.forename: Julie L
authors.initials: JL
authors.lastname: Kangas
authors.forename: Edward S
authors.initials: ES
authors.lastname: Friedman
authors.forename: Judith A
authors.initials: JA
authors.lastname: Callan
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D012008:Recurrence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult