Factors Associated with Attrition from Mindfulness-Based Cognitive Therapy in Patients with a History of Suicidal Depression

“…(five items, described by the authors as ‘moody pondering’ e.g. “think ‘why can’t I handle things better?’”) and reflection (five items referring to neutrally valenced pondering, e.g. ‘analyse recent events to try and understand why you are depressed’; see Treynor et al. 2003 for factor analysis).”

“Two previous trials of MBCT for recurrent depression have demonstrated that the treatment significantly reduces the risk of relapse over a 12-month period in those with three or more depressive episodes (Ma and Teasdale 2004; Teasdale et al. 2000), with a more recent trial demonstrating that MBCT has equivalent result…”

“Similarly Carmody and Baer (2008) reported drop-out figures for participants attending MBSR classes at the University of Massachusetts Medical School in 2006 who consented to participate in a research study exploring the effects of home practice on outcome.”

“…from those who remained in treatment: having a history of two, rather than three or more episodes of depression (associated with increased likelihood of dropout; Ma and Teasdale 2004) and having a history of attempted suicide (associated with increased likelihood of dropout; Kuyken et al. 2008).”

“Finally Brown et al. (2005) managed to retain almost all the participants in their trial of cognitive therapy for suicide attempters (only two out of 60 did not attend cognitive therapy) but did so in the context of very intensive efforts including the use of study case managers.”

“…from those who remained in treatment: having a history of two, rather than three or more episodes of depression (associated with increased likelihood of dropout; Ma and Teasdale 2004) and having a history of attempted suicide (associated with increased likelihood of dropout; Kuyken et al. 2008).”

“Although these levels of dropout compare favourably with dropout from treatment trials for patients with acute depression (e.g. Evans et al. 1992, 40% attrition by 12 weeks for antidepressants and/or cognitive therapy; Warden et al. 2009, Star*D, 27% attrition by 12 weeks for antidepressant…”

“Research in substance abuse populations shows that low levels of psychological distress tolerance predict early dropout from treatment (Daughters et al. 2005), and it would be interesting in future research to explore the extent to which the same is true of MBCT.”

“This trial was conducted as a feasibility and acceptability study, and the main outcomes have been reported elsewhere (Williams et al. 2008, primary outcomes; Crane et al. 2008; Hepburn et al. 2009, secondary outcomes).”

“Previous research has shown that it is problem-solving effectiveness, rather than number of relevant means, which differentiates participants with a history of suicidal ideation from those with a history of non-suicidal depression (Williams et al. 2005).”

“The support provided by the group and the realisation of not being alone in suffering from depression have been repeatedly identified as core to the experience of MBCT in qualitative studies (e.g. Mason and Hargreaves 2001; Allen et al. 2009).”

“Although MBCT may hold promise for these patients (e.g. Williams et al. 2006), difficulties with engagement and retention in treatment can be pronounced.”

“…psychological treatment, and might also be a marker of more generally elevated levels of cognitive reactivity There is growing evidence that suicidality is also associated with increased levels of rumination (see Morrison and O’Connor 2008 for a systematic review of the literature in this area).”

“For example, in the POPMACT trial of brief CBT for suicide attempters, 38% of those allocated to CBT treatment failed to attend even one treatment session (Tyrer et al. 2003).”

“Although these levels of dropout compare favourably with dropout from treatment trials for patients with acute depression (e.g. Evans et al. 1992, 40% attrition by 12 weeks for antidepressants and/or cognitive therapy; Warden et al. 2009, Star*D, 27% attrition by 12 weeks for antidepressant treatment) and dropout from…”

“Rudd et al. (1996) found a 21% drop-out rate in a treatment study of young suicidal adults.”

“For example, Kabat-Zinn and Chapman-Waldrop (1988) reviewed adherence in a standard 8-week MBSR programme over a 2-year period and found an average completion rate of 76%, with 9% attending no sessions and a further 15% dropping out after the beginning of the programme, usually within the first few…”

“The support provided by the group and the realisation of not being alone in suffering from depression have been repeatedly identified as core to the experience of MBCT in qualitative studies (e.g. Mason and Hargreaves 2001; Allen et al. 2009).”

“This trial was conducted as a feasibility and acceptability study, and the main outcomes have been reported elsewhere (Williams et al. 2008, primary outcomes; Crane et al. 2008; Hepburn et al. 2009, secondary outcomes).”

“This trial was conducted as a feasibility and acceptability study, and the main outcomes have been reported elsewhere (Williams et al. 2008, primary outcomes; Crane et al. 2008; Hepburn et al. 2009, secondary outcomes).”

“A similar finding has been observed for dropout from personality disorder services (Crawford et al. 2009) with whom our population of previously suicidal patients may have some overlap.”

“…treatment trials for patients with acute depression (e.g. Evans et al. 1992, 40% attrition by 12 weeks for antidepressants and/or cognitive therapy; Warden et al. 2009, Star*D, 27% attrition by 12 weeks for antidepressant treatment) and dropout from cognitive behavioural therapy (CBT) as part of…”

“We informed participants’ general practitioners of their patients’ allocated treatment, the dates of treatment sessions (if applicable), and the point at which patients ended their participation in the trial.”