Psychiatr Serv 60:898-907, July 2009
doi: 10.1176/appi.ps.60.7.898
© 2009 American Psychiatric Association
Dropout From Outpatient Mental Health Care in the United States
Mark Olfson, M.D., M.P.H.,
Ramin Mojtabai, M.D., Ph.D.,
Nancy A. Sampson, B.S.,
Irving Hwang, M.A.,
Benjamin Druss, M.D., M.P.H.,
Philip S. Wang, M.D., Dr.P.H.,
Kenneth B. Wells, M.D., M.P.H.,
Harold Alan Pincus, M.D. and
Ronald C. Kessler, Ph.D.
Dr. Olfson is affiliated with the New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore. Ms. Sampson, Mr. Hwang, and Dr. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Dr. Wang is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Wells is with the Department of Psychiatry, University of California, Los Angeles. Dr. Pincus is with the Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University and New York-Presbyterian Hospital, New York City. Send correspondence to Dr. Kessler at the Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115-5899 (kessler{at}hcp.med.harvard.edu).
OBJECTIVE: Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood. This study explored patterns and predictors of mental health treatment dropout in a nationally representative sample. METHODS: Data were from the National Comorbidity Survey Replication, a nationally representative household survey. Respondents who had received mental health treatment in the 12 months before the interview (N=1,664) were asked about dropout, which was defined as quitting treatment before the provider wanted them to stop. Cross-tabulation and discrete-time survival analyses were used to identify predictors. RESULTS: Approximately one-fifth (22%) of patients quit treatment prematurely. The highest dropout rate was from treatment received in the general medical sector (32%), and the lowest was from treatment received by psychiatrists (15%). Dropout rates were intermediate from treatment in the human services sector (20%) and among patients seen by nonpsychiatrist mental health professionals (19%). Over 70% of all dropout occurred after the first or second visits. Mental health insurance was associated with low odds of dropout (odds ratio=.6, 95% confidence interval=.4–.9). Psychiatric comorbidity was associated with a trend toward dropout. Several patient characteristics differentially predicted dropout across treatment sectors and in early and later phases of treatment. CONCLUSIONS: Roughly one-fifth of adults in mental health treatment dropped out before completing the recommended course of treatment. Dropout was most common in the general medical sector and varied by patient characteristics across treatment sectors. Interventions focused on high-risk patients and sectors that have higher dropout rates will likely be required to reduce the large proportion of patients who prematurely terminate treatment.
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