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Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials
Abstract
Dropout from mental health treatment poses a substantial problem, but rates vary substantially across studies and diagnoses. Focused reviews are needed to provide more detailed estimates for specific areas of research. Randomized clinical trials involving individual psychotherapy for unipolar depression are ubiquitous and important, but empirical data on average dropout rates from these studies is lacking. We conducted a random-effects meta-analysis of 54 such studies (N=5852) including 80 psychotherapy conditions, and evaluated a number of predictors of treatment- and study-level dropout rates. Our overall weighted dropout estimates were 19.9% at the study level, and 17.5% for psychotherapy conditions specifically. Therapy orientation did not significantly account for variance in dropout estimates, but estimates were significantly higher in psychotherapy conditions with more patients of minority racial status or with comorbid personality disorders. Treatment duration was also positively associated with dropout rates at trend level. Studies with an inactive control comparison had higher dropout rates than those without such a condition. Limitations include the inability to test certain potential predictors (e.g., socioeconomic status) due to infrequent reporting. Overall, our findings suggest the need to consider how specific patient and study characteristics may influence dropout rates in clinical research on individual therapy for depression.
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“A more focused meta-analysis reviewing only individual psychotherapy for major depression found a similar drop-out rate of 19.9% (Cooper & Conklin, 2015).”
From Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health (2022) · cites this paper as Cooper & Conklin, 2015
In the citing paper
“First, Copper and Conklin found an increased attrition risk of 23.5% from trials involving an inactive control condition (which is relevant to Phases I and II of our data here).”
From Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health (2022) · cites this paper as Cooper & Conklin, 2015
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Flagged first, then by citations
Research works printed but not linked: 1
- Higgins, 2011, Chapter eight: Assessing risk of bias in included studies
Cited by
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Carlbring, P., Andersson, G., Cuijpers, P., Riper, H., & Hedman-Lagerlöf, E. (2018) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1401115 · Cited by 1,232
“In fact, the average dropout rate across the studies was 15.7%, which is perfectly in line with a recent meta-analysis on dropouts from individual psychotherapy for major depression (Cooper & Conklin, 2015).”
ResultInfluentialLewis, C., Roberts, N. P., Gibson, S., & Bisson, J. I. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1709709 · Cited by 382
“5% obtained from a meta-analysis of dropout from RCTs of psychotherapy for depression [24] that defined dropout as unexpected attrition among individuals who were randomized to a treatment but failed to complete it.”
BackgroundStubbs, B., Vancampfort, D., Rosenbaum, S., Ward, P. B., Richards, J., Soundy, A., Veronese, N., Solmi, M., & Schuch, F. B. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.10.019 · Cited by 284
“Unsurprisingly, dropouts from treatment represent a major barrier that preclude an individual benefitting from an intervention and appear to be a particular problem in people with depression (Cooper and Conklin, 2015).”
BackgroundMethodResultInfluentialThe Role of Exercise in Preventing and Treating Depression
Schuch, F. B., & Stubbs, B. (2019) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000620 · Cited by 298
“For example, dropout rate from psychotherapies, in general, is about 19% (50) while the dropout rate from selective serotonin reuptake inhibitors are about 26% and tricyclics about 28% (51).”
BackgroundInternet-Based Cognitive-Behavioral Therapy for Depression: Current Progress and Future Directions
Webb, C. A., Rosso, I. M., & Rauch, S. L. (2017) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000139 · Cited by 217
Metadata
- Authors
- Cooper, A. A., & Conklin, L. R.
- Affiliations
- Case Western Reserve University (US)
- Boston University (US)
- Corresponding author
- Cooper, Andrew A.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 40
- Pages
- 57-65
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W243214355
- Cited by
- 264
- References
- 56
- Citations by year
- 2026: 35 · 2025: 32 · 2024: 30 · 2023: 30 · 2022: 29 · 2021: 24 · 2020: 25 · 2019: 9 · 2018: 18 · 2017: 14 · 2016: 11 · 2015: 4
- FWCI
- 2.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Social Sciences and Humanities Research Council of Canada
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- treatment discontinuation, individual psychotherapy, major depressive disorder, predictors of dropout, personality disorders, treatment duration, psychotherapy research
- MeSH terms
- Major Depressive Disorder, Humans, Patient Dropouts, Psychotherapy, Randomized Controlled Trials as Topic
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