Is dropout after a first psychotherapy visit always a bad outcome?

OBJECTIVE: The authors compared outcomes reported by patients who did or did not return for treatment after an initial psychotherapy visit. METHODS: Members of a group health plan were surveyed about initial psychotherapy visits occurring between March and September 2010. The survey assessed satisfaction with care and therapeutic alliance during the visit and later clinical improvement. RESULTS: Of the 2,666 members who returned surveys, 906 (34%) did not return for a second visit within 45 days. The distribution of satisfaction, therapeutic alliance, and self-rated improvement scores between patients who did and did not return differed significantly (p<.001). Patients who did not return were more likely to report the most favorable and the least favorable outcomes. CONCLUSIONS: Failure to return after an initial psychotherapy visit can represent successful and satisfying treatment. Systematic outreach and outcome assessment are necessary to identify the patients who drop out of therapy after unsuccessful and unsatisfying treatment.

Association of perceived barriers with prospective use of VA mental health care among Iraq and Afghanistan veterans.

OBJECTIVE: The relationship between perceived barriers and prospective use of mental health care among veterans was examined. METHODS: The sample included Iraq and Afghanistan veterans (N=305) who endorsed symptoms of depression or posttraumatic stress disorder (PTSD) or alcohol misuse at intake to a postdeployment clinic between May 2005 and August 2009. Data on receipt of adequate treatment (nine or more mental health visits in the year after intake) were obtained from a VA database. RESULTS: Adequate treatment was more likely for women (odds ratio [OR]=4.82, 95% confidence interval (CI)=1.37-16.99, p=.014) and for those with more severe symptoms of PTSD (OR=1.03, CI=1.01-1.05, p=.003) and depression (OR=1.06, CI=1.01-1.11, p=.01). Perceived barriers were not associated with adequate treatment. CONCLUSIONS: Male veterans with mental health problems should be targeted with outreach to reduce unmet need. Research is needed to identify perceived barriers to treatment among veterans.