Warnick Erin M, Gonzalez Araceli, Robin Weersing V, Scahill Lawrence, Woolston Joseph
Yale University, Child Study Center, 230 S. Frontage, New Haven, Connecticut 06511, USA. E-mail:
San Diego State University, University of California, USA.
Child Adolesc Ment Health. 2012 May;17(2):76-85. doi: 10.1111/j.1475-3588.2011.00606.x. Epub 2011 Jun 15.
Attrition is a long-standing problem in mental health centres serving youth. However, attempts to understand attrition have not consistently identified the same risk factors. The way in which attrition was defined across studies may have had a significant impact on findings. This study examines three definitions of attrition across a large sample of children and adolescents receiving outpatient mental health services, and considers the different relationships observed between the identified predictors and each definition.
This study examined data collected concurrently from 1098 families who received services at an urban outpatient mental health clinic (OMHC). Logistic regression was used to examine the association between identified predictor variables and attrition, using three distinct definitions of attrition based on clinician judgment, missed last appointment, and specified dose. The results of each regression analysis were qualitatively compared to assess the impact on findings observed when applying different definitions of attrition.
As anticipated, observed predictors of attrition varied by definition. Ethnicity predicted attrition across all definitions. Residing in a single-caregiver household predicted attrition across two of the three definitions, while living with a non-biological family, receiving state-funded, low-income insurance support, having low parent-reported youth functioning, routine intakes (as compared to urgent intakes), and longer wait predicted attrition within only one definition.
Rates and factors associated with attrition may vary substantially depending on how treatment attrition is defined. In the evaluation of attrition in youth mental health settings, the definition used should be clearly stated and should reflect the research question posed.
在为青少年提供服务的心理健康中心，治疗中断是一个长期存在的问题。然而，试图理解治疗中断现象的研究并未始终确定相同的风险因素。各研究中治疗中断的定义方式可能对研究结果产生了重大影响。本研究在接受门诊心理健康服务的大量儿童和青少年样本中考察了治疗中断的三种定义，并考虑了所确定的预测因素与每种定义之间观察到的不同关系。
本研究考察了从一家城市门诊心理健康诊所（OMHC）接受服务的1098个家庭同时收集的数据。使用逻辑回归来检验所确定的预测变量与治疗中断之间的关联，治疗中断采用基于临床医生判断、错过最后一次预约和规定剂量的三种不同定义。对每项回归分析的结果进行定性比较，以评估应用不同治疗中断定义时对观察结果的影响。
正如预期的那样，观察到的治疗中断预测因素因定义而异。种族在所有定义中都可预测治疗中断。在三种定义中的两种中，单亲家庭可预测治疗中断，而与非亲生家庭生活、接受国家资助的低收入保险支持、父母报告的青少年功能较低、常规就诊（与紧急就诊相比）以及等待时间较长仅在一种定义中可预测治疗中断。
与治疗中断相关的发生率和因素可能因治疗中断的定义方式而有很大差异。在评估青少年心理健康环境中的治疗中断时，应明确说明所使用的定义，并应反映所提出的研究问题。
