Mavissakalian Matig R, Guo Shenyang
Department of Psychiatry, Case Western Reserve University and The Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA.
Compr Psychiatry. 2002 Mar-Apr;43(2):88-94. doi: 10.1053/comp.2002.30803.
Three hundred thirty-three consecutive individuals with panic and agoraphobic-like symptoms were evaluated as part of the screening for entry in a long-term imipramine treatment study of panic disorder with agoraphobia. The present report compares three subgroups of potential subjects--those who entered the study (n = 139, 41.7%), those who were rejected from participation based on exclusion criteria (n = 161, 48.3%), and those who qualified to enter but refused participation (n = 33, 10.0%)-in order to characterize pretreatment attrition and address two specific questions: What variables other than inclusion and exclusion criteria predict the likelihood of entering the trial?, and What variables significantly predict the likelihood of refusal to participate? Logistic regression analysis revealed that the likelihood of entering the trial was influenced significantly and independently by a number of variables that included extroversion, anxiety, and work satisfaction and performance measures. The refused and rejected groups differed significantly on a number of variables that were not a priori exclusionary criteria, such as a history of substance abuse other than alcohol and current use of alcohol to decrease anxiety, but none of these variables emerged as independent, significant predictors of refusing behavior as a separate category of nonparticipation. Findings suggest the presence of factors common to both the rejected and the refused groups that significantly influence pretreatment attrition and caution that categorizing pretreatment attrition into refused and rejected categories may not always be clear cut. Research and clinical implications are briefly discussed.
333名有惊恐和广场恐怖症样症状的连续个体作为进入一项关于伴有广场恐怖症的惊恐障碍的长期丙咪嗪治疗研究的筛选的一部分接受了评估。本报告比较了潜在受试者的三个亚组——进入研究的受试者（n = 139，41.7%）、基于排除标准被拒绝参与的受试者（n = 161，48.3%）以及符合进入条件但拒绝参与的受试者（n = 33，10.0%）——以便描述治疗前损耗情况并回答两个具体问题：除了纳入和排除标准外，哪些变量可预测进入试验的可能性？以及哪些变量能显著预测拒绝参与的可能性？逻辑回归分析显示，进入试验的可能性受到包括外向性、焦虑以及工作满意度和绩效指标等多个变量的显著且独立的影响。拒绝参与组和被拒绝组在一些并非先验排除标准的变量上存在显著差异，比如除酒精外的物质滥用史以及当前使用酒精来减轻焦虑，但这些变量均未成为作为非参与的一个单独类别的拒绝行为的独立、显著预测因素。研究结果表明，被拒绝组和拒绝参与组存在共同因素，这些因素显著影响治疗前损耗，并警示将治疗前损耗分为拒绝参与和被拒绝两类可能并不总是清晰明确的。本文简要讨论了研究和临床意义。
