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Cited by 37Treatment of Major DepressionMedication Adherence and ComplianceMental Health Treatment and Access

Dropout Prevalence and Associated Factors in Randomized Clinical Trials of Adolescents Treated for Depression: Systematic Review and Meta-analysis

Rohden, Adriane Isabel, Benchaya, Mariana Canellas, Camargo, Roger Santos, Moreira, Taís de Campos, Barros, Helena M.T., Ferigolo, Maristela·2017·Clinical Therapeutics
DOI 10.1016/j.clinthera.2017.03.017
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Abstract

Purpose Depression currently affects 350 million people, and its prevalence among adolescents is 4% to 8%. Adolescents who abandon antidepressant treatment or drop out of clinical trials are less likely to recover or experience a remission of symptoms because they are not being followed up by a medical team. The objective of this study was to analyze the dropout rates of randomized clinical trials of depressed adolescents receiving treatment with antidepressant drugs and the factors associated with nonadherence by summarizing this information in a systematic review and meta-analysis.Methods Articles were retrieved from MEDLINE, EMBASE, Cochrane, Clinical Trial, PsycINFO, and Web of Science using the MeSH terms "depressive disorder," "randomized trials," and "adolescents." The evaluation of study quality was performed by using the Cochrane Handbook for Systematic Reviews of Interventions and the Jadad scale.Findings The final sample included 50 articles, of which 44 presented dropout rates. The overall dropout prevalence was 23% (95% CI, 20-27; P < 0.0001). Participants aged ≥16 years, those treated with serotonin norepinephrine reuptake inhibitors, and those receiving medication only exhibited the highest dropout prevalence, respectively (33% [95% CI, 27-39], 45% [95% CI, 31-64], and 15% [95% CI, 13-17]). The adverse effects most associated with dropout were attempted suicide followed by mania, skin rash, and headache. Problems relating to clinical trials and family arbitration were also related with dropout.Implications Serotonin/norepinephrine reuptake inhibitor treatment, adolescent age >16 years, and receiving medication were the only factors demonstrating a higher association with dropout rates. Selective serotonin reuptake inhibitors were linked to the lowest prevalence, probably due to fewer perceived problems with related adverse effects and higher efficacy in adolescents. Cognitive-behavioral therapy combined with pharmacotherapy produced a lower nonadherence prevalence; this approach can be an alternative to avoid dropouts and relapse. Prospero identifier: CRD42014013475.

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  • A meta-analysis found dropout rates for psychological and drug therapy among adolescents were approximately 23% and 45%, respectively.

    “A meta-analysis of the effectiveness of treatment for depression in adolescents found that the dropout rates regarding psychological and drug therapy among adolescents were approximately 23% and 45%, respectively [59].”

    From Systematic review and meta-analysis of the effects of exercise on depression in adolescents (2022) · cites this paper as [59]

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Authors
Rohden, A. I., Benchaya, M. C., Camargo, R. S., Moreira, T. D. C., Barros, H. M. T., & Ferigolo, M.
Affiliations
Universidade Federal de Ciências da Saúde de Porto Alegre (BR)
Corresponding author
Rohden, Adriane Isabel
ORCID
Venue
Clinical Therapeutics
Publisher
Elsevier BV
Published
2017-05
Volume
39
Issue
5
Pages
971-992.e4
ISSN
0149-2918 (ISSN-L)
DOI
10.1016/j.clinthera.2017.03.017
OpenAlex
W2610575797
Cited by
35
References
120
Citations by year
2026: 4 · 2025: 6 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 4 · 2020: 3 · 2019: 3
FWCI
0.21
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Clinical Therapeutics (publishedVersion)
  • PubMed (publishedVersion)
Funders
Conselho Nacional de Desenvolvimento Científico e Tecnológico
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
adolescent depression, trial dropout, antidepressant treatment, treatment non-adherence, serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, adverse drug reactions, suicide attempts, family arbitration, cognitive behavioral therapy, pharmacotherapy
MeSH terms
Adolescent, Antidepressive Agents, Depression, Humans, Patient Dropouts, Randomized Controlled Trials as Topic

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