Predictors and Patterns of Dropout From Psychiatric Treatment Among Trauma-Affected Refugees: A Large Data Pool Analysis

Abstract

Dropout from mental health treatment is a substantial hindrance to relevant and effective treatment. Despite the high prevalence of PTSD among refugees, research into their treatment dropout has received limited attention. This study aimed to identify patterns and predictors of treatment dropout versus completion through different treatment stages. The sample included 940 patients with a refugee background undergoing outpatient treatment for PTSD in Denmark. All patients were offered 10 medical doctor sessions and 16–20 psychotherapy sessions. Dropout was analysed in three stages: (1) during the first six MD sessions, (2) during the first eight psychotherapy sessions upon completion of Stage 1, and (3) during psychotherapy sessions 9 to 16. A stepwise multiple regression analysis was conducted for each stage to identify predictors of stage-specific dropout. Counter to expectations, both early dropout and full completion were associated with better symptom outcomes, relative to late-treatment dropout. Key predictors varied by stage, with younger age predicting early dropout, whereas chronic pain and poor Danish proficiency predicted late dropout. Female gender and a clearly articulated motivation for active participation were predictors for full treatment completion. Practical advice is suggested to accommodate at-risk patients and to re-evaluate patient engagement after familiarisation with treatment.