Determinants of dropout in a community-based mental health crisis centre.
BACKGROUND
Dropping out during the course of medical follow up is defined as an early therapy withdrawal without the agreement of the therapist. In a psychiatric crisis unit in Geneva, we empirically observed that almost 50% of the patients were not showing up to their first appointments, which were scheduled for 3 to 7 days post discharge.


METHODS
The aim of this naturalistic descriptive cohort study is to identify the demographic, patient and care-related predictive factors of dropout in a community-based psychiatric crisis centre. We included 245 consecutive outpatients followed-up for 4 to 6 weeks of intensive outpatient psychiatric treatment. Logistic regression models were built to examine the association between dropout and demographic, care and patient-related variables.


RESULTS
Among the 245 outpatients, dropout occurred in 37.5% of cases, and it most frequently occurred (81.8%) in the first 2 days of follow-up. Among care-related variables, referral by hospital units or private psychiatrists led to significantly lower levels of dropout compared to patients referred by the psychiatric emergency unit (respectively: OR = .32; p = .04; 95% CI [.10, .93]; OR = .36; p = .04; 95% CI [.13, .96]; OR = .22; p = .002; 95% CI [.08, .58]). Among patient-related variables, younger age increased the risk of dropout (OR = .96; 95%; p = .002; 95% CI [.94, .99]). Anxiety and personality but not mood disorders were also related to higher rates of dropout (respectively: OR = 2.40; p = .02; 95% CI [1.14, 4.99]; and OR = 1.98; p = .02; 95% CI [1.09, 3.59]). Unipolar depression (72.2%; OR = 1.47; p = .48; 95% CI [.34, 1.21]) was the most frequent primary diagnosis in this sample.


CONCLUSIONS
This study makes clear the need for increased efforts to improve care adherence in young patients with anxious or personality disorders seen in emergency rooms because they are prone to early discontinuation of treatments. Future studies in this field are warranted to gain a better understanding into the complex reasons that surround discontinuation of care in outpatient settings.
Mental Health and Psychiatry Department, University Hospitals of Geneva, CAPPI Jonction: 35, rue des Bains, 1205, Geneva, Switzerland.
Alexandre
A
Henzen
Mental Health and Psychiatry Department, University Hospitals of Geneva, CAPPI Jonction: 35, rue des Bains, 1205, Geneva, Switzerland.
Clotilde
C
Moeglin
Psychiatric Department, University Hospitals of Geneva, Chemin du Petit-Bel-Air 2, CH- 1225, Chêne-Bourg, Switzerland.
Panteleimon
P
Giannakopoulos
Catchment Area and Mental Health Units, Mental Health and Psychiatric Department, University Hospitals of Geneva, CAPPI Jonction: 35, rue des Bains, 1205, Geneva, Switzerland. o.sentissi@hcuge.ch.
Othman
O
Sentissi
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003155:Community Mental Health Centers; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000523:psychology* / Q000706:statistics & numerical data
Attachment; Crisis centre; Dropout; Mentally ill patient