Dropout From Outpatient Mental Health Care in the United States

Objectives-Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood.This study explores patterns and predictors of mental health treatment dropout in a nationally representative sample.Methods-Data come from the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey.Respondents in mental health treatment in the 12 months (n=1,664) before interview were asked about dropout defined as quitting treatment before the provider wanted.Cross-tabulation and discrete-time survival analyses were used to identify predictors.Results-Approximately one-fifth (22.4%) of patients quit treatment prematurely.The highest dropout rate was from the general medical sector (31.6%) and the lowest was from psychiatrists (15.1%).Dropout rates were intermediate in the human service sector (19.7%) and among patients seen by non-psychiatrist mental health professionals (18.9%).Over 70% of all dropout occurred after the first or second visits.Mental health insurance was associated with low odds of dropout (0.6, 0.4-0.9).Psychiatric comorbidity was associated with a trend towards 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 each year drop out before completing the recommended course of treatment.Dropout is most common in the general medical sector and varies by patient characteristics across treatment sectors.Interventions focused on highrisk patients and sectors will likely be required to reduce the high proportion of patients who prematurely terminate treatment.