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PubMed1994

Dropping out of child psychotherapy: distinguishing early and late dropouts over the course of treatment.

The present study examined child, parent, and family factors that predict dropping out from therapy among children (ages 4-13) referred for the treatment of oppositional, aggressive, and antisocial behavior. It was proposed that factors predicting attrition would vary as a function of whether families dropped out early or late in treatment. Several factors related to family (e.g., socioeconomic disadvantage, adverse child-rearing practices), parent (e.g., stress, life events, history of antisocial behavior), and child functioning (e.g., severity and chronicity of antisocial behavior, lower IQ, peer relations) predicted premature termination from treatment. A different pattern was evident in the factors predicting early and late termination from therapy. The findings have implications for conceptualizing the process of engaging and retaining families in treatment and for preventing premature termination.

Adolescent↗
PubMed1969

Doctor or dropout?

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Education, Medical↗
PubMed1996

Time-limited group psychotherapy for patients with personality disorders: outcomes and dropouts.

This study reports on the time-limited (18-month long) group therapy of 49 outpatients, most of whom were diagnosed with DSM-III-R, Axis II personality disorders (American Psychiatric Association, 1987). Although many patients did not complete the full course of treatment, those who did experienced many areas of change. Completers reported substantial changes in self-esteem, symptomatology, and diagnosability on Axis II. This type of group treatment appears to be a promising mode of intervention for those with personality disorders.

Adult↗
PubMed1996

Analysis of repeated measurements with dropouts among Alzheimer's disease patients using summary measures and meta-analysis.

A method of stratifying the data according to the patterns of missing observations, summarizing each subject's repeated measurements by a summary measure and then comparing the treatment groups with the help of a distribution-free test based on the summary measure, is used here to compare the efficacy of tacrine dose regimens with that of placebo in a recent trial in Alzheimer's disease patients. The usefulness of the method of meta-analysis for comparing the treatment groups, in the presence of missing data, is also investigated.

Alzheimer Disease↗
PubMed2002

Comparison of alternative strategies for analysis of longitudinal trials with dropouts.

PROBLEM: Patients may withdraw from longitudinal clinical trials for many reasons. Methods for handling the problem presented by missing data of patients who withdraw before reaching the time point of the primary measurement include carrying the last observation forward (LOCF), data as observed analysis (DAO), mixed model approaches, and pattern mixture models. METHOD: We evaluate a multiple imputation (MI) approach that has the flexibility to adjust inferences about the treatment effect for the withdrawn patients relative to currently used alternatives. Sensitivity analyses are performed under a collection of scenarios that include many circumstances that may arise in practice, including different assumptions about treatment effects post-withdrawal and about the missing data mechanism. Simulations are used to compare the results of analyses based on the MI approach with those based on the LOCF, DAO, and the mixed model approaches. RESULTS: The LOCF and DAO approaches cannot be recommended as strategies for handling missing responses, at least for these scenarios, because they provide biased estimates of treatment effects and biased tests of the null hypothesis of no treatment effect. Application of the various approaches to the analysis of clinical data from a longitudinal trial confirms the underestimation of the variability when the LOCF approach is used.

Analysis of Variance↗
PubMed1989

Physician dropout.

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Clinical Protocols↗
PubMed1998

Side effects, dropouts from treatment and cost consequences.

Estimating the cost of treatment of depression has to take into account the quantifiable direct costs of medication, and hospital and community care, and the indirect costs such as loss of productivity, unemployment, costs of social support, etc. It also has to take into account the intangible costs to the depressed individual which are more difficult to quantify. Depression is a long-term illness and is associated with considerable morbidity and mortality which contribute substantially to the indirect costs of the illness. Successful treatment can be expected to reduce the overall costs of depression to the individual and to society at large. Compliance with treatment is an essential factor in the successful treatment of depression. Meta-analyses of published papers have indicated that significantly more patients discontinue treatment with tricyclic antidepressants due to side effects than with selective serotonin reuptake inhibitors and therefore better tolerated antidepressants should be the first choice of treatment. Pharmacoeconomic studies that take account of the failure of treatment represented by the discontinuations due to side effects show that an apparently cheaper antidepressant like imipramine may turn out to be more expensive than the better tolerated antidepressants.

Antidepressive Agents↗