Administration and Policy in Mental Health and Mental Health Services Research

Firth, Nick

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Administration and Policy in Mental Health and Mental Health Services Research

Abstract

Dropout during psychological intervention is a signifcant problem. Previous evidence for associations with socioeconomic deprivation is mixed. This study aimed to review the evidence for associations between deprivation and dropout from contemporary adult psychological interventions for common mental disorders (CMDs). Systematic review, narrative synthesis and random efects meta-analysis of peer-reviewed English language journal articles published June 2010–June 2020 was conducted. Data sources included medline, PsycInfo, databases indexed by web of science, ProQuest social science database and sociology collection, and the Cochrane Library, supplemented by forward and backward citation searching. Five studies were eligible for inclusion (mean N=170, 68% female, 60% White Caucasian, 32% dropout rate, predominantly cognitive behaviour therapy/cognitive processing therapy). Narrative synthesis indicated an overall non-signifcant efect of deprivation on dropout. Meta-analytic signifcance of controlled (k=3) and uncontrolled (k=4) efects depended on the measure of deprivation included for those studies using more than one measure (controlled OR 1.21–1.32, p=0.019–0.172, uncontrolled OR 1.28–1.76, p=0.024–0.423). The low number of included studies meant sub-group comparisons were limited, despite some tentative indications of potential diferential effects. A comparator set of excluded studies showed similar uncertainty. There was limited evidence that did not overall suggest a clear signifcant effect of deprivation on dropout from contemporary individual CMD interventions. However, more contemporary research is needed, as effects may vary according to clinical and methodological factors, and for dropout versus non-initiation.