Brief Treatment and Crisis Intervention Advance Access originally published online on October 12, 2005
Brief Treatment and Crisis Intervention 2005 5(4):356-367; doi:10.1093/brief-treatment/mhi027
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Original Article |
Dropout in Institutional Emotional Crisis Counseling and Brief Focused Intervention
From the Institute of Clinical Psychiatry, Department of Neurosciences, Padova University
Contact author: Luigi Pavan, Full Professor of Psychiatry, Institute of Clinical Psychiatry, Dipartimento di Neuroscienze, Università degli Studi di Padova, Via Giustiniani 5, 35128 Padova, Italy. E-mail: psichiatria{at}unip.it
Increasingly scarce economic resources prompt the need for more efficient forms of health care; hence, brief outpatient crisis intervention has therapeutic and preventive goals with respect to suicide risk. The aim of this study was to assess which factors predict nonnegotiated termination of treatment. Patients who dropped out of treatment (n = 26) were compared with those who concluded treatment (n = 102). Intervention, which resembled outpatient-focused brief supporting psychotherapy, consisted of 10 weekly sessions lasting 45–50 min. The first session envisaged an initial consultation; the following 2 sessions consisted of in-depth assessment, presentation of the intervention, and a battery of tests. Axis I, Axis II personality (Structured Clinical Interview for DSM IV, Axis II Personality Disorders), depression (Hamilton Depression Rating Scale, Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), anger (State-Trait Anger Expression Inventory), social adaptation (Social Adaptation Self-Evaluation Scale), and global functioning (Global Assessment Scale) were also clinically evaluated. The total dropout rate in the study was 20.3%. Logistic regression analysis identified borderline personality disorder as a predictor of dropout, which was associated with a mean age of less than 30 years, a prevalence of female gender, and the tendency to act out (dropout in the final sessions) and slightly correlated with a propensity for interpersonal deficits and lower resources or social support. No major differences were observed in Axis I, and the adopted clinical instruments did not seem able to predict dropout by clinical–symptomatological "magnitude." Even in crisis situations, dropping out appears to be correlated with borderline personality disorder (Diagnostic and Statistical Manual of Mental Disorders [4th ed.]). The extent to which this depends on crisis remission or poses a barrier to treatment remains to be seen.
KEY WORDS: dropout, crisis, anxiety, depression, borderline personality