Association between complexity and adherence to psychotherapy in outpatients awaiting psychotherapy for mood and personality disorders.

Background: The Measure of Common Characteristics that Complicate Care (C4) is a clinician-administered checklist designed to quantify characteristics that could complicate care in outpatient psychiatry. This study investigated the C4 checklist against disturbance of personality function and early adherence to psychotherapy.

Methods: The recruits for the trial were patients awaiting group psychotherapy in psychotherapy outpatient clinics, who were scored with the C4 and responded to the Level of Personality Functioning Scale-Brief Form (LPFS-BF) questionnaire. We compared differences in case complexity across diagnostic groups and the correlation with the LPFS-BF. Finally, we evaluated the usefulness of the C4 in identifying those who attended ≥ 3 of their first four sessions of psychotherapy by conducting receiver operating characteristic (ROC) curves and linear regression analysis with percentage adherence as a dependent variable.

Results: One hundred and fifty-nine patients with emotional disorders, personality disorders, and PTSD were included. Of these, 86 started their psychotherapy courses during the study and were included in the prediction analysis. C4 scores did not differ between diagnostic groups and were not correlated with the LPFS-BF. ROC analysis indicated poor accuracy (AUC=.46) in screening for early adherence to psychotherapy, as did analyses with the LPFS-BF as a cofactor.

Conclusions: The C4 was not able to predict early adherence to psychotherapy in psychiatric outpatients, and as it also had no correlation with personality functioning, it was not possible to establish external validity. Future studies should investigate case complexity using a more controlled design and examine the outcomes of psychotherapy and adherence.