Finnish Institute for Health and Welfare, Finland.
Nord J Psychiatry. 2021 Dec;75(sup1):S2. doi: 10.1080/08039488.2021.2019902. Epub 2022 Mar 14.
Patient factors make a strong contribution to psychotherapy outcome. Pre-treatment patient characteristics - demographic, pathology and personal - may either facilitate achievement of recovery and lasting benefits or constitute a risk for different kinds of treatment failure.
A narrative review focused on evaluating the role of pre-treatment patient characteristics on the success or failure of short- and long-term psychotherapy for mood and anxiety disorders. Success was conceptualized as significant improvement or recovery and failure as non-improvement, deterioration, or non-attendance/dropout.
There is no consistent evidence of demographic variables as predictors of treatment failure, except for lower socioeconomic status, being male and ethnic minority status for therapy non-attendance. Patients' pathology, i.e. severity of psychiatric symptoms, greater functional impairment, personality disorder and other comorbidities, have been shown to be mostly associated with lesser recovery across different types of disorders, especially in short-term therapies, but it does not consistently predict treatment failure. Some pre-treatment personal characteristics (e.g. secure attachment style) and capacities (e.g. motivation, self-observing capacity and good overall psychological suitability) mostly increase the likelihood of therapy success whereas some vulnerabilities and poor psychological suitability, or overall complexity (i.e. combination of demographic, clinical and personality factors), increase the risk of poor outcome mostly in short-term but not in long-term therapy, or moderate dropout. Likewise, the subsequent match between therapy type and patient's pre-treatment expectations and preferences may account for different aspects of treatment failure.
The relative importance of pre-treatment patient characteristics on treatment failure is not known. Meta-analyses on this issue are needed.
患者因素对心理治疗结果有很大影响。治疗前的患者特征——人口统计学、病理学和个人特征——可能会促进康复和持久获益的实现，也可能构成不同类型治疗失败的风险。
本文聚焦于评估治疗前患者特征对情绪和焦虑障碍的短期和长期心理治疗成功或失败的作用。成功被定义为显著改善或康复，失败则被定义为无改善、恶化或不治疗/脱落。
除了社会经济地位较低、男性和少数民族身份与治疗不依从相关外，人口统计学变量作为治疗失败的预测因素，目前尚无一致证据。患者的病理学，即精神症状的严重程度、更大的功能障碍、人格障碍和其他共病，与不同类型疾病的康复率较低相关，尤其是在短期治疗中，但并不一致地预测治疗失败。一些治疗前的个人特征（例如，安全依恋模式）和能力（例如，动机、自我观察能力和良好的整体心理适宜性）大多增加了治疗成功的可能性，而一些脆弱性和较差的心理适宜性，或整体复杂性（即人口统计学、临床和人格因素的组合），则增加了短期治疗而非长期治疗中不良结局或中度脱落的风险。同样，治疗类型与患者治疗前的期望和偏好之间的后续匹配可能会影响治疗失败的不同方面。
目前尚不清楚治疗前患者特征对治疗失败的相对重要性。需要对此问题进行荟萃分析。
