Predictors of early dropout from psychotherapy for depression in community practice.

OBJECTIVE: Data from a managed care health system were used to examine demographic, clinical, and health system predictors of early dropout from psychotherapy for depression.
METHODS: A total of 238 members of a mixed-model health plan calling to request an initial psychotherapy visit for depression completed a brief survey regarding depression severity, perceived need for treatment, and expected benefit. Claims records were used to assess therapy visits attended over the following 90 days.
RESULTS: Dropout rates before the first therapy visit were somewhat higher among women (p=.041) and younger members (p=.017), moderately higher among those with lower depression severity (p=.012), and markedly higher among callers referred to network-model psychotherapists (compared with those given appointments with group-model therapists at health plan clinics) (p<.001). By the second visit, however, cumulative dropout rates were similar for group- and network-model therapists. The only significant predictors of cumulative dropout rates before the second visit were less severe depression at the screening call (p=.004) and lower self-rated importance of initiating psychotherapy (p=.046).
CONCLUSIONS: Early dropout from psychotherapy for depression was only weakly related to consumers' demographic characteristics. Dropout rates were lower among those with more severe depression, but a significant number of persons with moderate or severe symptoms of depression still discontinued treatment before the second visit. Allocation of visits for individual consumers was markedly different for group- and network-model psychotherapists, but these data did not allow for examination of differences in outcomes for those two treatment models.