Martins Dayane Santos, Bermudez Mariane Bagatin, de Abreu Costa Marianna, Fleck Marcelo P A, Salum Giovanni Abrahão, Dreher Carolina Blaya, Manfro Gisele Gus
Postgraduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
Program of Anxiety Disorders, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Sci Rep. 2024 Dec 5;14(1):30316. doi: 10.1038/s41598-024-81327-9.
Premature dropout from psychotherapy can harm patients and increase mental health costs. This study identified predictors of dropout in brief online psychotherapy for essential workers during the COVID-19 pandemic. This was a secondary analysis of a randomized trial on 4-week CBT or IPT protocols. Participants provided sociodemographic data and completed the Patient-Reported Outcomes Measurement Information System and Burnout Assessment Tool Short-Form. Predictors were analyzed in three blocks: sociodemographic, clinical, and therapist characteristics using bivariable and multivariable analyses. The sample included 804 individuals who attended at least the first session of either CBT (n = 403) or IPT (n = 401). A total of 17.2% (n = 138) of the participants dropped out during the protocol. Significant predictors of dropout included having children (IRR = 1.48; 95% CI: 1.07-2.05; p = 0.016), residing in specific regions of Brazil (Northeast IRR = 1.44; 95% CI:1.04-2.00; p = 0.02 and Midwest IRR = 1.73; 95%CI: 1.13-2.64; p = 0.01), therapist male sex (IRR = 2.04; 95% CI: 1.47-2.83; p = < 0.001), second wave of Covid-19 (IRR = 1.54; 95% CI: 1.01-2.34; p = 0.04) and low life satisfaction (IRR = 1.63; 95% CI: 1.06-2.50; p = 0.02). Our findings underscore the necessity for culturally tailored strategies, support for those with children, and targeted therapy for individuals with low life satisfaction. Implementation of these strategies may reduce dropout rates and improve treatment outcomes for essential workers in crisis.
心理治疗中的过早退出会对患者造成伤害，并增加心理健康成本。本研究确定了在新冠疫情期间为一线工作者提供的简短在线心理治疗中退出治疗的预测因素。这是一项对为期4周的认知行为疗法（CBT）或人际心理治疗（IPT）方案的随机试验的二次分析。参与者提供了社会人口学数据，并完成了患者报告结局测量信息系统和倦怠评估工具简表。使用双变量和多变量分析在三个组块中分析预测因素：社会人口学、临床和治疗师特征。样本包括804名至少参加了CBT（n = 403）或IPT（n = 401）第一阶段治疗的个体。共有17.2%（n = 138）的参与者在治疗方案期间退出。退出的显著预测因素包括有孩子（风险比[IRR]=1.48；95%置信区间[CI]：1.07 - 2.05；p = 0.016）、居住在巴西特定地区（东北部IRR = 1.44；95%CI：1.04 - 2.00；p = 0.02，中西部IRR = 1.73；95%CI：1.13 - 2.64；p = 0.01）、治疗师为男性（IRR = 2.04；95%CI：1.47 - 2.83；p = < 0.001）、新冠疫情第二波（IRR = 1.54；95%CI：1.01 - 2.34；p = 0.04）以及生活满意度低（IRR = 1.63；95%CI：1.06 - 2.50；p = 0.02）。我们的研究结果强调了采用文化适应策略、为有孩子的人提供支持以及针对生活满意度低的个体进行有针对性治疗的必要性。实施这些策略可能会降低一线工作者在危机中的退出率，并改善治疗效果。
