Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders

Issakidis, C.; Andrews, G.

doi:10.1111/j.1600-0047.2004.00264.x

Cited by 150Mental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders

Issakidis, C., Andrews, G.·2004·Acta Psychiatrica Scandinavica

DOI 10.1111/j.1600-0047.2004.00264.x

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Abstract

Objective: Treatment attrition represents a considerable problem for efficient delivery of care for mental disorders. The present study examined rates and predictors of pretreatment attrition and dropout from outpatient treatment for anxiety disorders. Method: The influence of clinical, demographic, clinician and system variables on pretreatment attrition (treatment refusal or non‐attendance) and dropout were analysed in a consecutive sample of 731 clients treated at an anxiety disorders clinic in Sydney. Results: Pretreatment attrition was common (30.4%) but dropout once clients had commenced treatment was rare (10.3%). Milder pretreatment symptoms were associated with treatment dropout and comorbid depression or depressive symptoms were associated with higher probability of both pretreatment attrition and dropout. Demographic, clinician and system influences were present but less important. Conclusion: Targeting of individuals with comorbid anxiety and depression may reduce treatment attrition rates among individuals with anxiety disorders presenting for treatment.

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Our data show a relatively high dropout rate, but it was no different from that found in clinical trials of group CBT for anxiety disorders.
“Although our data show a relatively high dropout rate, it was no different from that found in clinical trials of group CBT for anxiety disorders (see Fernandez, Salem, Swift, & Ramtahal, 2015;Issakidis & Andrews, 2004, for a review).”
From Efficacy of an acceptance-based group behavioral therapy for generalized anxiety disorder. (2020) · cites this paper as Issakidis & Andrews, 2004
Group treatments for anxiety disorders have approximately twice the attrition rate of individual treatments.
“The comparison between adherences to individual (Hunot, Churchill, Silva de Lima, & Teixeira, 2007) and group (Issakidis & Andrews, 2004) treatments for anxiety disorders suggests that the latter has approximately twice the attrition rate of the former.”
From Efficacy of an acceptance-based group behavioral therapy for generalized anxiety disorder. (2020) · cites this paper as Issakidis & Andrews, 2004
Many patients do not benefit sufficiently from exposure-based therapy for anxiety disorders.
“Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it.”
From Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE) (2023) · cites this paper as [12]
About 25-30% of patients refuse to start exposure therapy because they find it too aversive.
“about 25–30% of patients refuse to start exposure therapy, because they find it too aversive [11, 12]”
From Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE) (2023) · cites this paper as [12]
About 10-20% of patients drop out of exposure therapy prematurely.
“about 10–20% of patients drop out prematurely [12–14]”
From Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE) (2023) · cites this paper as [12]

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Authors: Issakidis, C., & Andrews, G.
Affiliations: UNSW Sydney (AU)
Corresponding author: Issakidis, C.
ORCID: Andrews, G.
Venue: Acta Psychiatrica Scandinavica
Publisher: Wiley
Published: 2004-04-29
Volume: 109
Issue: 6
Pages: 426-433
ISSN: 0001-690X (ISSN-L)
1600-0447
DOI: 10.1111/j.1600-0047.2004.00264.x
OpenAlex: W2114685224
Cited by: 149
References: 40
Citations by year: 2026: 5 · 2025: 2 · 2024: 2 · 2023: 7 · 2022: 7 · 2021: 5 · 2020: 13 · 2019: 6 · 2018: 8 · 2017: 4 · 2016: 12 · 2015: 8 · 2014: 12 · 2013: 7 · 2012: 10
FWCI: 6.94
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Acta Psychiatrica Scandinavica (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords: treatment discontinuation, anxiety disorders, outpatient psychotherapy, comorbid depression, depressive symptoms, predictors of dropout, treatment refusal, mental health service delivery
MeSH terms: Adult, Anxiety Disorders, Depression, Disability Evaluation, Female, Humans, Male, Patient Dropouts, Surveys and Questionnaires, Severity of Illness Index, Comorbidity, Cognitive Behavioral Therapy

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Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders

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