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Original Investigation
December 4, 2019

Association of Patient Treatment Preference With Dropout and Clinical Outcomes in Adult Psychosocial Mental Health Interventions: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
JAMA Psychiatry. Published online December 4, 2019. doi:10.1001/jamapsychiatry.2019.3750
Key Points

Question  Is the receipt of a preferred treatment associated with dropout and clinical outcomes in adult psychosocial mental health interventions?

Findings  This systematic review and meta-analysis of 29 randomized clinical trials involving 5294 participants with a mental health diagnosis found that receiving preferred psychosocial mental health treatment was associated with lower dropout rates and had a medium positive association with therapeutic alliance. There was no evidence of a significant association with clinical outcomes.

Meaning  Offering patients with a mental health diagnosis their preferred treatment is associated with important aspects of engagement in psychosocial interventions; these findings strengthen existing policy and guidance on ensuring informed treatment choice in mental health care.

Abstract

Importance  Receiving a preferred treatment has previously been associated with lower dropout rates and better clinical outcomes, but this scenario has not been investigated specifically for psychosocial interventions for patients with a mental health diagnosis.

Objective  To assess the association of patient treatment preference with dropout and clinical outcomes in adult psychosocial mental health interventions via a systematic review and meta-analysis.

Data Sources  The Cochrane Library, Embase, PubMed, PsychINFO, Scopus, Web of Science, Nice HDAS (Healthcare Databases Advanced Search), Google Scholar, BASE (Bielefeld Academic Search Engine), Semantic Scholar, and OpenGrey were searched from inception to July 20, 2018, and updated on June 10, 2019.

Study Selection  Studies were eligible if they (1) were a randomized clinical trial; (2) involved participants older than 18 years; (3) involved participants with mental health diagnoses; (4) reported data from a group of participants who received their preferred treatment and a group who received their nonpreferred treatment or who were not given a choice; and (5) offered at least 1 psychosocial intervention.

Data Extraction and Synthesis  Two researchers extracted study data for attendance, dropout, and clinical outcomes independently. Both assessed the risk of bias according to the Cochrane tool. Data were pooled using random-effects meta-analyses.

Main Outcomes and Measures  The following 7 outcomes were examined: attendance, dropout, therapeutic alliance, depression and anxiety outcomes, global outcomes, treatment satisfaction, and remission.

Results  A total of 7341 articles were identified, with 34 eligible for inclusion. Twenty-nine articles were included in the meta-analyses comprising 5294 participants. Receiving a preferred psychosocial mental health treatment had a medium positive association with dropout rates (relative risk, 0.62; 0.48-0.80; P < .001; I2 = 44.6%) and therapeutic alliance (Cohen d = 0.48; 0.15-0.82; P = .01; I2 = 20.4%). There was no evidence of a significant association with other outcomes.

Conclusions and Relevance  This is the first review, to our knowledge, examining the association of receiving a preferred psychosocial mental health treatment with both engagement and outcomes for patients with a mental health diagnosis. Patients with mental health diagnoses who received their preferred treatment demonstrated a lower dropout rate from treatment and higher therapeutic alliance scores. These findings underline the need to accommodate patient preference in mental health services to maximize treatment uptake and reduce financial costs of premature dropout and disengagement.

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