title: Premature termination of treatment for anorexia nervosa: differences between patient-initiated and staff-initiated discharge.
abstract: OBJECTIVE
  To investigate treatment drop-out by comparing clinical indicators of patients whose discharge was initiated by staff with those who initiated discharge themselves.
  
  
  METHODS
  Ninety participants with anorexia completed questionnaires at admission and four weeks into hospitalized treatment. Weight data was collected over this same period. At discharge, participants were categorized into completer (n = 38) or patient-initiated (n = 36) /staff-initiated (n = 16) premature termination groups.
  
  
  RESULTS
  Significant differences between staff-initiated and patient-initiated discharge groups were found at admission. Staff initiated groups were on average older (p = .035), and more likely to have had prior compelled treatment (p = .039). At 4 weeks those in the patient-initiated group had put on weight at a faster rate (p = .032) and reported a decrease in alliance (p = .017). At discharge, staff initiated discharge demonstrated greater time in treatment (p = .001), greater weight gain (p = .027), and a higher discharge BMI (p = .013). At discharge, staff-initiated drop-outs had comparable end-of-treatment outcomes to those who completed treatment as planned.
  
  
  CONCLUSIONS
  There are key differences between those who prematurely discharge themselves from treatment, compared to those who are prematurely discharged by clinical staff. Future research into drop-out needs to take into account and recognize these differences.
authors: School of Nursing Sciences, University of East Anglia, Norwich, United Kingdom, NR7 4TJ; Eating Disorders Research Team, St George's, University of London, London, United Kingdom, SW17 0RE.
authors: Richard
authors: R
authors: Sly
authors: Victoria A
authors: VA
authors: Mountford
authors: John F
authors: JF
authors: Morgan
authors: J Hubert
authors: JH
authors: Lacey
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology* / Q000628:therapy; D015992:Body Mass Index; D003068:Coercion; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D013811:Psychotherapeutic Processes; D016079:Refusal to Treat / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
keywords: anorexia nervosa; behavior change; dropout; motivation; therapeutic alliance; treatment outcome