Dropout in a clinical trial for comorbid PTSD and MDD among US service members: Are pretreatment characteristics predictive?

IF 2.6 1区心理学 Q2 PSYCHOLOGY, CLINICAL

Psychotherapy Research Pub Date : 2025-04-01 Epub Date: 2024-03-18 DOI:10.1080/10503307.2024.2325519

Alexander C Kline, Nicholas P Otis, Sonya B Norman, W Michael Hunt, Kristen H Walter

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引用次数: 0

Abstract

Objective: Despite effective treatment options for posttraumatic stress disorder (PTSD), many patients do not complete therapy. This includes U.S. active duty service members, yet factors linked to attendance in this population remain understudied and dropout remains difficult to predict. Additionally, most studies have not examined samples with PTSD and co-occurring major depressive disorder (MDD) despite high rates of comorbidity.

Method: The current study explored predictors of dropout among service members with comorbid PTSD and MDD (N = 94) randomized to cognitive processing therapy enhanced with behavioral activation (BA + CPT) or CPT as part of a clinical trial.

Results: Using the Fournier approach, only two predictors were associated with lower dropout risk among over 20 examined: shorter duration between pretreatment assessment and Session 1 (p = .041) and past 3-month PTSD treatment engagement (p = .036).

Conclusion: Results suggest the possible utility of early momentum in starting therapy and leveraging recent treatment to improve attendance. However, this study also highlights the possible limitations of commonly assessed pretreatment factors in predicting attendance and current challenges in measuring dropout risk. Strategies to improve prediction, such as shifting focus to assess modifiable factors and processes more proximal to dropout during treatment, may be needed.Trial registration: ClinicalTrials.gov identifier: NCT02874131.

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美国军人中合并创伤后应激障碍和抑郁障碍的临床试验中的辍学现象：治疗前的特征是否具有预测性？

目的：尽管创伤后应激障碍（PTSD）的治疗方法很有效，但许多患者并没有完成治疗。这其中就包括美国现役军人，但与这一人群接受治疗有关的因素仍未得到充分研究，辍学情况仍难以预测。此外，尽管创伤后应激障碍（PTSD）和重度抑郁障碍（MDD）的合并率很高，但大多数研究都没有对这一人群进行研究：本研究探讨了在临床试验中随机接受认知加工疗法（BA + CPT）或认知加工疗法（CPT）治疗的并发创伤后应激障碍和重度抑郁症患者（N = 94）的辍学预测因素：采用傅尼叶方法，在超过 20 个受试者中，只有两个预测因素与较低的辍学风险相关：治疗前评估与疗程 1 之间的持续时间较短（p = .041），以及创伤后应激障碍治疗参与时间超过 3 个月（p = .036）：研究结果表明，尽早开始治疗和利用最近的治疗来提高就诊率可能是有用的。然而，本研究也强调了通常评估的治疗前因素在预测出勤率方面可能存在的局限性，以及目前在衡量辍学风险方面所面临的挑战。可能需要改进预测的策略，如将重点转移到评估可改变的因素和治疗期间更接近辍学的过程：试验注册：ClinicalTrials.gov identifier：NCT02874131.

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来源期刊

Psychotherapy Research PSYCHOLOGY, CLINICAL-

CiteScore

7.80

自引率

10.30%

发文量

期刊介绍： Psychotherapy Research seeks to enhance the development, scientific quality, and social relevance of psychotherapy research and to foster the use of research findings in practice, education, and policy formulation. The Journal publishes reports of original research on all aspects of psychotherapy, including its outcomes, its processes, education of practitioners, and delivery of services. It also publishes methodological, theoretical, and review articles of direct relevance to psychotherapy research. The Journal is addressed to an international, interdisciplinary audience and welcomes submissions dealing with diverse theoretical orientations, treatment modalities.