title: Evaluation of factors associated with psychiatric patient dropout at a university outpatient clinic in Japan.
abstract: BACKGROUND
  Patient dropout from treatment can lead to a deterioration in clinical condition, thereby increasing the need for more intensive therapy that incurs substantial social and economic losses. The aim of this study was to identify factors related to psychiatric patient dropout at a university outpatient clinic in Japan.
  
  
  METHODS
  We retrospectively examined the medical charts of new psychiatric patients who were diagnosed with either a mood disorder (International Classification of Diseases, 10th revision, code: F3) or an anxiety disorder (F4) in the outpatient clinic at Kyoto Prefectural University of Medicine Hospital in Kyoto, Japan, between April 2010 and March 2013. The baseline characteristics of the patients (age, sex, Global Assessment of Functioning score, Clinical Global Impression-Severity of Illness score, education, occupation, marital status, duration of treatment, and prior treatment history), treating psychiatrist experience in years, and sex concordance between the patients and their treating psychiatrists were analyzed using Cox regression models.
  
  
  RESULTS
  From among 1,626 eligible new patients during the study period, 532 patients were enrolled in the study (F3: n=176; F4: n=356). The dropout rate was 35.7%, which was similar to that of previous studies. Higher educational level, being married, and lower Global Assessment of Functioning scores were associated with a lower dropout rate. Although psychiatrist experience was not significantly associated with patient dropout in the multivariate analysis, patients treated by less experienced psychiatrists had a higher hazard ratio for dropout (1.31; 95% confidence interval: 0.94-1.85).
  
  
  CONCLUSIONS
  In order to reduce the dropout rate, special focus should be placed on patients with the factors identified in this study, and young psychiatrists should undergo further education to foster adherence.
authors.affiliation: Department of Psychiatry.
authors.forename: Atsumi
authors.initials: A
authors.lastname: Minamisawa
authors.affiliation: Department of Psychiatry.
authors.forename: Jin
authors.initials: J
authors.lastname: Narumoto
authors.affiliation: Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Yokota
authors.affiliation: Department of Psychiatry.
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukui
keywords: anxiety disorders; mood disorders; outpatient care; patient dropout; psychiatry