Moderators of Dropout in Short-Term Psychodynamic Psychotherapy and Cognitive Behavioral Therapy for Depression: A Meta-Analytic Review of Individual Participant Data
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2023-02-03
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en
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Abstract
Introduction: Short-Term Psychodynamic Psychotherapy (STPP) and Cognitive-Behavioural
Therapy (CBT) are both empirically supported treatments for depression. Nevertheless,
treatment of depression suffers from high dropout prevalence, which is related to poorer
treatment outcomes. It is still unclear which factors are associated with dropout, especially
between different treatments. Investigating factors that may affect the likelihood to dropout of
depression treatment might be of crucial importance to provide individual treatment
recommendations. Therefore, the aim of the present individual participant data (IPD) meta analysis was to explore clinical and demographic patient moderators (e.g., baseline depression
and gender) that might be associated with the likelihood of dropout in STPP and CBT.
Methods: A meta-analytic review with individual participant data of N = 373 depressed
adults was conducted. The included studies were limited to randomized controlled trials
comparing STPP and CBT in adult patients suffering from a major depressive disorder or any
other unipolar mood illness. Participants were regarded as dropout when exhibiting a missing
post-assessment score. A binary logistic regression model was applied to identify differences
in dropout rates between STPP and CBT. Several moderating variables (e.g., gender,
education, marital status) were investigated regarding differences between STPP and CBT.
Results: Findings revealed an overall dropout rate of 24.1% (STPP = 27.8%; CBT = 20%).
Furthermore, treatment did not predict dropout, indicating no differences in dropout between
STPP and CBT. Marital status significantly moderated treatment dropout as such that
unmarried patients were more likely to drop out in STPP compared to CBT, while there was
no difference in married patients.
Conclusion: Marital Status might serve as a crucial distinctive factor of dropout between
STPP and CBT. Although this further uncovers patient-related variables of treatment dropout,
further research is needed on specific underlying reasons of dropout between psychological
interventions (e.g., therapist variables).
Keywords: dropout, depression, individual participant data meta-analysis, short-term
psychodynamic psychotherapy, cognitive behavioural therapy
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Faculteit der Sociale Wetenschappen