Patients receiving mental health care in the general medical sector are
those most likely to stop their treatment prematurely, while patients treated
by psychiatrists are least likely to do so, according to an analysis of data
from a U.S. national survey.
Mark Olfson, M.D., M.P.H., and colleagues analyzed data collected from the
National Comorbidity Survey Replication and found that 22.4 percent of the
1,164 adult respondents who had received mental health treatment in the prior
12 months told the survey interviewers that they had quit treatment before the
care provider wanted them to.
The dropout rates differed by the type of health care professionals.
Patients receiving care in general medicine by primary care physicians,
nurses, or other health professionals had a treatment dropout rate of 32
percent, while those seen by psychiatrists had a 15 percent rate (see
The general medical sector was also the most frequently used source of
mental health care, providing it for more than half (52 percent) of the
"The rates of treatment dropout vary widely across general medicine
depending on the disease, patient population, and specific treatment,"
Olfson told Psychiatric News. He pointed out that the 22.4 percent
overall dropout rate in mental health treatment closely resembles the
discontinuation rates for patients receiving some other medical treatments,
such as adults prescribed beta-blockers following cardiac catheterization
(also 22 percent). "Although the dropout rates from [treatment by]
psychiatrists were lower than those from other health care professionals,
premature discontinuation of psychiatric care remains unacceptably
common," he noted.
Olfson is a professor of clinical psychiatry at Columbia University College
of Physicians and Surgeons and the New York State Psychiatric Institute.
Conducted from 2001 to 2003, the National Comorbidity Survey Replication
collected mental disorder data from face-to-face interviews in a nationally
representative community sample of adults throughout the United States. The
study was published in the July Psychiatric Services.
The authors sifted through an abundance of survey data to uncover a number
of factors that may help clinicians identify patients at a high risk of
prematurely terminating treatment for mental illness. For example, race and
ethnicity generally were not associated with treatment dropout, except that
non-Hispanic black patients were significantly more likely than whites to drop
out of treatment with psychiatrists than with general medical or
nonpsychiatrist mental health professionals. In addition, younger
patients—those aged 18 to 29—were more likely to drop out after
the first two visits than were patients aged 60 or older, a trend that reached
statistical significance only among those treated by psychiatrists.
Certain clinical and social characteristics also significantly predicted
treatment dropout in all treatment settings. "Patients who lack health
insurance and those who have not previously received mental health services
were both at exceptionally high risk of dropping out of psychiatric
care," Olfson emphasized. "Economic realities as well as the
patient's familiarity with mental health care are likely to weigh heavily on
[his or her] decision to continue or prematurely terminate
In the overall assessment across providers, patients with substance use
disorders were more likely to drop out after the first two visits, but
patients receiving collaborative care from several types of health
professionals, such as a psychiatrist working with a general physician, were
more likely to remain in treatment.
The authors also discovered that the first two visits were critical for
convincing patients to stick with the treatment. More than 70 percent of all
dropouts took place after one or two visits. Olfson urged clinicians to focus
on engaging patients in the first few encounters. "Some patient groups,
particularly younger adults, were at a high risk of dropout during the early
stage of treatment," he noted.
"Dropout From Outpatient Mental Health Care in the United
States" is posted at<ps.psychiatryonline.org/cgi/content/full/60/7/898>.▪