For the study, Joshua Swift, Ph.D., an assistant professor of psychology at Idaho State University, and colleagues analyzed data from 186 studies that compared rates of treatment refusal or premature termination by patients with psychiatric disorders who were assigned to psychotherapy, pharmacotherapy, or a combination of psychotherapy and pharmacotherapy. Of the 186 studies included in the analysis, 57 (6,693 patients) included information on patients who refused treatment recommendations, and 182 (17,891 patients) included information on those who prematurely terminated treatment.
The researchers found that the average refusal rate was 8.2% across all studies. Patients assigned to pharmacotherapy alone were 1.76 times more likely to fail to initiate their treatment than patients who were assigned to psychotherapy alone. Further analyses comparing refusal rates by psychiatric disorder revealed rates of treatment refusal were greatest in patients with panic disorder and depression, who were found to be, respectively, 2.79 and 2.16 times more likely to refuse pharmacotherapy than their condition-matched counterparts who were assigned to psychotherapy.
For patients who began treatment, 21.9% failed to complete the recommended regimen, and those assigned to pharmacotherapy alone were on average 1.20 times more likely to drop out compared with those assigned to psychotherapy. Rates of premature termination were highest in patients with anorexia/bulimia and patients with depression, respectively, who were 2.46 times and 1.26 times more likely to terminate prematurely than their condition-matched counterparts who were assigned to psychotherapy.
“Based on these results, we believe that in addition to considering treatment efficacy, treatment referrers and providers and those who develop treatment guidelines should consider refusal and dropout rates when making treatment recommendations,” wrote Swift and colleagues. “After all, a highly effective treatment can only work if clients are willing to engage in it.”
For related information, see the Psychiatric News article “Motivational Interviewing for Clinical Practice: Just Do It,” by Carla Marienfeld, M.D., of the University of California, San Diego; Bachaar Arnaout, M.D., of Yale School of Medicine; and Petros Levounis, M.D., of Rutgers New Jersey Medical School.