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Association of Patient Treatment Preference With Dropout and Clinical Outcomes in Adult Psychosocial Mental Health Interventions: A Systematic Review and Meta-analysis.
JAMA Psychiatry ( IF 22.5 ) Pub Date : 2019-12-04 , DOI: 10.1001/jamapsychiatry.2019.3750 Emma Windle 1 , Helena Tee 1 , Alina Sabitova 1 , Nikolina Jovanovic 1 , Stefan Priebe 1 , Catherine Carr 1
JAMA Psychiatry ( IF 22.5 ) Pub Date : 2019-12-04 , DOI: 10.1001/jamapsychiatry.2019.3750 Emma Windle 1 , Helena Tee 1 , Alina Sabitova 1 , Nikolina Jovanovic 1 , Stefan Priebe 1 , Catherine Carr 1
Affiliation
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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.
中文翻译：
成人心理社会心理干预中患者治疗偏好与辍学和临床结果的关联：系统评价和荟萃分析。
重要性以前，接受首选治疗与降低辍学率和改善临床结局有关，但是这种情况尚未针对具有心理健康诊断的患者的社会心理干预进行专门研究。目的通过系统评价和荟萃分析，评估成人心理社会心理健康干预措施中患者治疗偏好与辍学和临床结局之间的关系。数据源从开始到7月20日，对Cochrane库，Embase，PubMed，PsychINFO，Scopus，Web of Science，Nice HDAS（医疗数据库高级搜索），Google Scholar，BASE（Bielefeld学术搜索引擎），语义学者和OpenGrey进行了搜索。 ，2018年和2019年6月10日更新。研究选择如果研究（1）是随机临床试验，则符合研究条件；（2）年满18岁的参与者；（3）参加者有心理健康诊断；（4）从一组接受了首选治疗的参与者和一组接受了非首选治疗或没有选择的参与者中报告的数据；（5）至少提供了1次社会心理干预。数据提取和综合两名研究人员分别提取了研究数据，包括出勤率，辍学率和临床结局。两者均根据Cochrane工具评估了偏倚的风险。使用随机效应荟萃分析汇总数据。主要结果和措施检查了以下7个结果：出勤，辍学，治疗联盟，抑郁和焦虑结果，总体结果，治疗满意度和缓解。结果共鉴定出7341篇文章，其中34篇符合纳入标准。在包括5294名参与者的荟萃分析中包含29篇文章。接受首选的心理社会心理健康治疗与辍学率（相对风险，0.62; 0.48-0.80; P <.001; I2 = 44.6％）和治疗联盟（Cohen d = 0.48; 0.15-0.82; P = 0.01； I2 = 20.4％）。没有证据表明与其他结果有显着关联。结论和相关性据我们所知，这是第一篇综述，探讨了接受心理社会心理健康治疗的首选与精神健康诊断患者的参与度和结局之间的关系。接受过首选治疗的患有精神健康诊断的患者表现出较低的辍学率和较高的治疗联盟得分。
更新日期：2020-03-05
中文翻译：
成人心理社会心理干预中患者治疗偏好与辍学和临床结果的关联：系统评价和荟萃分析。
重要性以前，接受首选治疗与降低辍学率和改善临床结局有关，但是这种情况尚未针对具有心理健康诊断的患者的社会心理干预进行专门研究。目的通过系统评价和荟萃分析，评估成人心理社会心理健康干预措施中患者治疗偏好与辍学和临床结局之间的关系。数据源从开始到7月20日，对Cochrane库，Embase，PubMed，PsychINFO，Scopus，Web of Science，Nice HDAS（医疗数据库高级搜索），Google Scholar，BASE（Bielefeld学术搜索引擎），语义学者和OpenGrey进行了搜索。 ，2018年和2019年6月10日更新。研究选择如果研究（1）是随机临床试验，则符合研究条件；（2）年满18岁的参与者；（3）参加者有心理健康诊断；（4）从一组接受了首选治疗的参与者和一组接受了非首选治疗或没有选择的参与者中报告的数据；（5）至少提供了1次社会心理干预。数据提取和综合两名研究人员分别提取了研究数据，包括出勤率，辍学率和临床结局。两者均根据Cochrane工具评估了偏倚的风险。使用随机效应荟萃分析汇总数据。主要结果和措施检查了以下7个结果：出勤，辍学，治疗联盟，抑郁和焦虑结果，总体结果，治疗满意度和缓解。结果共鉴定出7341篇文章，其中34篇符合纳入标准。在包括5294名参与者的荟萃分析中包含29篇文章。接受首选的心理社会心理健康治疗与辍学率（相对风险，0.62; 0.48-0.80; P <.001; I2 = 44.6％）和治疗联盟（Cohen d = 0.48; 0.15-0.82; P = 0.01； I2 = 20.4％）。没有证据表明与其他结果有显着关联。结论和相关性据我们所知，这是第一篇综述，探讨了接受心理社会心理健康治疗的首选与精神健康诊断患者的参与度和结局之间的关系。接受过首选治疗的患有精神健康诊断的患者表现出较低的辍学率和较高的治疗联盟得分。
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