title: Reducing Dropout in Treatment for Depression: Translating Dropout Predictors Into Individualized Treatment Recommendations.
abstract: OBJECTIVE
  Premature discontinuation of therapy is a widespread problem that hampers the delivery of mental health treatment. A high degree of variability has been found among rates of premature treatment discontinuation, suggesting that rates may differ depending on potential moderators. In the current study, our aim was to identify demographic and interpersonal variables that moderate the association between treatment assignment and dropout.
  
  
  METHODS
  Data from a randomized controlled trial conducted from November 2001 through June 2007 (N = 156) comparing supportive-expressive therapy, antidepressant medication, and placebo for the treatment of depression (based on DSM-IV criteria) were used. Twenty prerandomization variables were chosen based on previous literature. These variables were subjected to exploratory bootstrapped variable selection and included in the logistic regression models if they passed variable selection.
  
  
  RESULTS
  Three variables were found to moderate the association between treatment assignment and dropout: age, pretreatment therapeutic alliance expectations, and the presence of vindictive tendencies in interpersonal relationships. When patients were divided into those randomly assigned to their optimal treatment and those assigned to their least optimal treatment, dropout rates in the optimal treatment group (24.4%) were significantly lower than those in the least optimal treatment group (47.4%; P = .03).
  
  
  CONCLUSIONS
  Present findings suggest that a patient's age and pretreatment interpersonal characteristics predict the association between common depression treatments and dropout rate. If validated by further studies, these characteristics can assist in reducing dropout through targeted treatment assignment.
  
  
  BACKGROUND
  Secondary analysis of data from ClinicalTrials.gov identifier: NCT00043550.
authors.affiliation: Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel. sigalzil@gmail.com.|Department of Psychology, University of Haifa, Haifa, Israel.
authors.forename: Sigal
authors.initials: S
authors.lastname: Zilcha-Mano
authors.affiliation: Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Keefe
authors.affiliation: The Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, New York, USA.
authors.forename: Harold
authors.initials: H
authors.lastname: Chui
authors.affiliation: Department of Psychology, University of Haifa, Haifa, Israel.
authors.forename: Avinadav
authors.initials: A
authors.lastname: Rubin
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Marna S
authors.initials: MS
authors.lastname: Barrett
authors.affiliation: The Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, New York, USA.
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Barber
mesh_terms: D000328:Adult; D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000453:epidemiology; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data*; D010554:Personality Disorders / Q000453:epidemiology; D011613:Psychotherapy / Q000379:methods*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents