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Client-level predictors of treatment engagement,outcome and dropout:moving beyond demographics

General Psychiatry 2019年第6期32卷 316-326页

作者： Soo-jeong Youn Margaret-Anne Mackintosh Shannon Wiltsey Stirman Kay lie A Patrick Yesenia Aguilar Silvan Anna D Bartuska derri l shtasel luana Marques Deparment of Psychiatry Massachusetts General HospitalBostonMassachusettsUSA Harvard Medical School BostonMassachusettsUSA Stat Craft BrentwoodCaliforniaUSA Dissemination and Training Division National Center for PTSDVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA Department of Psychiatry and Behavioral Sciences Stanford University School of MedicineStanfordCaliforniaUSA

Background Despite the availability of evidence-based treatments for posttraumatic stress disorder(PTSD),significant heterogeneity in the effectiveness of PTSD treatment persists,especially in community settings.Client demographics used to understand this variability in treatment outcome and dropout have yielded mixed results.Despite increasing evidence for the importance of attending to treatment engagement in community settings,few studies have explored client-level predictors.Aim The purpose of this study is to explore client-level predictors of treatment outcome and dropout beyond client demographics,and to identify client-level predictors of treatment engagement in community settings.Method Secondary data analysis was conducted with data collected as part of an implementation-effectiveness hybrid study of cognitive processing therapy(CPT)for PTSD in a diverse community healthcentre.Providers(n=19)treated(n=52)clients as part of their routine clinical care.Non-demographic client-level predictors included barriers to treatment,quality of life,session-level language and employment history assessed at baseline.Treatment engagement included number of weeks in the study,number of sessions with repeated CPT content,number of unique CPT sessions attended,frequency of session attendance and consistency of session attendance.Results Results showed language as a significant predictor of treatment engagement.There were significant differences between Spanish and English-speaking clients,with the former having a tendency to repeat more session content than the latter(β=1.4 sessions,p=0.003),and also less likely to attend treatment frequently(r=0.62,p=0.009)and consistently(r=0.57,p=0.027)if high logistical and financial barriers were endorsed.Irrespective of language,clients who reported high quality of life at baseline were less likely to repeat CPT session content(β=-0.3,p=0.04),and those with increased baseline barriers to treatment had deceleration in PTSD symptom improvement over time(β=-0.62,p<0.05).In terms of tre

关键词： treatment beyond likely

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