Pretreatment attrition and formal withdrawal during treatment and their predictors: an exploratory study of the anxiety online data

• Published in: Journal of medical Internet research Vol. 16; no. 6; p. e152
• Main Authors: Al-Asadi, Ali M, Klein, Britt, Meyer, Denny
• Format: Journal Article
• Language: English
• Published: Canada Journal of Medical Internet Research 01.06.2014; Gunther Eysenbach MD MPH, Associate Professor; JMIR Publications Inc; JMIR Publications
• Subjects: Algorithms; Analysis; Analysis of Variance; Anxiety; Anxiety Disorders - therapy; Attrition; Care and treatment; Clinical outcomes; Clinical research; Clinical trials; Comorbidity; Compulsions; Datasets as Topic; Diagnostic and Statistical Manual; Dropping out; Female; Generalized anxiety disorder; Health; Health education; Health problems; Higher education; Humans; Infancy; Internet; Intervention; Interventions; Logistic Models; Male; Medical diagnosis; Medical research; Mental depression; Mental disorders; Mental Health; Mental health services; Multivariate analysis; Obsessive compulsive disorder; Original Paper; Panic attacks; Panic disorders; Patient Dropouts; Popularity; Population; Post traumatic stress disorder; Quality of Life; Questionnaires; School dropouts; Smoking; Social Support; Sociodemographic Factors; Stress (Psychology); Telemedicine; Therapists; Therapy; Training; Treatment programs; Variables; predictors, anxiety disorders; treatment withdrawal dropouts; e-mental health; Internet interventions; eTherapy; pretreatment attrition
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/jmir.2989

Although in its infancy, the field of e-mental health interventions has been gaining popularity and afforded considerable research attention. However, there are many gaps in the research. One such gap is in the area of attrition predictors at various stages of assessment and treatment delivery. This exploratory study applied univariate and multivariate analysis to a large dataset provided by the Anxiety Online (now called Mental Health Online) system to identify predictors of attrition in treatment commencers and in those who formally withdrew during treatment based on 24 pretreatment demographic and personal variables and one clinical measure. Participants were assessed using a complex online algorithm that resulted in primary and secondary diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders (generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder) were offered an online 12-week disorder-specific treatment program. Of 9394 potential participants, a total of 3880 clients enrolled and 5514 did not enroll in one of the treatment programs following the completion of pretreatment assessment measures (pretreatment attrition rate: 58.70%). A total of 3199 individuals did not formally withdraw from the 12-week treatment cycle, whereas 142 individuals formally dropped out (formal withdrawal during treatment dropout rate of 4.25%). The treatment commencers differed significantly (P<.001-.03) from the noncommencers on several variables (reason for registering, mental health concerns, postsecondary education, where first heard about Anxiety Online, Kessler-6 score, stage of change, quality of life, relationship status, preferred method of learning, and smoking status). Those who formally withdrew during treatment differed significantly (P=.002-.03) from those who did not formally withdraw in that they were less likely to express concerns about anxiety, stress, and depression; to rate their quality of life as very poor, poor, or good; to report adequate level of social support; and to report readiness to make or were in the process of making changes. This exploratory study identified predictors of pretreatment attrition and formal withdrawal during treatment dropouts for the Anxiety Online program. Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).