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Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders
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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“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
In the citing paper
“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
In the citing paper
“Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it.”
In the citing paper
“about 25–30% of patients refuse to start exposure therapy, because they find it too aversive [11, 12]”
In the citing paper
“about 10–20% of patients drop out prematurely [12–14]”
In the citing paper
“Given that dropouts are common in this population [11–14]”
In the citing paper
“Furthermore, because pretreatment dropout is common in outpatient clinics [37]”
From Short-term effectiveness of web-based guided self-help for phobic outpatients: randomized controlled trial. (2014) · cites this paper as [37]
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Metadata
- 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
- 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
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Topics
- 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
- 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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