title: Factors affecting early attrition and later treatment course of antidepressant treatment of depression in naturalistic settings: an 18-month nationwide population-based study.
abstract: BACKGROUND
  Early attrition can impede treatment success of depression; its contributing factors and impacts on subsequent treatment course need further clarification.
  
  
  METHODS
  All Taiwanese adult patients prescribed with antidepressants for depression (n=216,557) in 2003 were identified through a total population health insurance claims database; their initial contact patterns could be classified into three types of attrition: non-attrition, returning attrition and non-returning attrition. Demographic and clinical characteristics associated with each attrition type were described and relationships between attrition type and subsequent treatment course over an 18-month follow-up period were examined with these demographic/clinical confounders being controlled for.
  
  
  RESULTS
  41.6% of Study subjects had early attrition; among them, 35.3% returned to treatment later. Type of depression, medical/psychiatric comorbidities, painful physical symptoms and past treatment history, as well as prescribing physician specialty and choice of antidepressants, were associated with early attrition. Three types of follow-up pattern over the 18-month follow-up period were identified: sustained treatment-free, continuous treatment and late re-contacts. Patients remaining engaged with treatment within the first three months had higher odds of achieving sustained treatment-free (OR=1.21; 99% CI: 1.16, 1.27) and lower odds of having late re-contacts (OR=0.20; 99% CI: 0.19, 0.21) over the 18-month period, compared to those who returned after early attrition.
  
  
  CONCLUSIONS
  Early attrition is a significant barrier for depression treatment in daily clinical practice and has negative impacts on later treatment course and/or outcome. Early attrition needs to be minimized through shared decision-making, exchange of treatment preferences and proper patient-physician communication.
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, King's College London, United Kingdom.
authors.forename: Yi-Ju
authors.initials: YJ
authors.lastname: Pan
authors.forename: Shi-Kai
authors.initials: SK
authors.lastname: Liu
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Yeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018672:Community Health Planning; D003695:Delivery of Health Care; D003863:Depression / Q000145:classification / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents