The impact of patient barriers and organizational factors on treatment dropout in posttraumatic stress disorder specialty care.

Abstract

Many veterans who begin evidence-based therapies for posttraumatic stress disorder (PTSD) discontinue care prior to treatment completion. Examination of individual-level factors as predictors of dropout has been inconclusive, and it may be important to examine organizational factors as predictors. The present study investigates the role of both individual variables (i.e., gender identity, age, racial background, ethnicity, perceived barriers to treatment) and organizational variables (i.e., time from evaluation to individual treatment, number of preparatory sessions, and inclusion of family in an informational session) in predicting treatment discontinuation. Participants consisted of 557 veterans who presented to a Veterans Affairs PTSD specialty clinic and began trauma-focused treatment (86.89% male, 50.99% White, 47.94% Operation Iraqi Freedom/Operation Enduring Freedom). Most veterans reported at least one barrier to treatment (85.10%). A total of 53.32% of veterans completed a course of evidence-based trauma-focused therapy, while 46.68% discontinued. In a series of logistic regression models, older age significantly predicted treatment completion (OR = 1.017, p = .007), and longer time from evaluation to treatment initiation significantly predicted treatment discontinuation (OR = 0.992, p = .045). Findings highlight older age as a reliable predictor of treatment completion among veterans. Findings add to the existing literature by demonstrating that improving organizational-level variables (i.e., reducing wait time from evaluation to treatment initiation) may be particularly helpful in facilitating treatment completion across demographic groups, even in the presence of barriers to treatment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).