Approximately 760,000 emerging adults use outpatient psychotherapy in the U.S. each year (Olfson et al.,2002). Emerging adults are 1.6-7.9 times more likely to drop out of mental health treatment than fully mature adults (Edlund et al., 2002; Olfson et al., 2002). This Study compared temporal patterns of attendance and non attendance between emerging and mature adult

Davis, Maryann

Fisher, William H.

Gershenson, Bernice

Lidz, Charles W.

English

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University of Massachusetts Medical School eScholarship@UMMS Implementation Science and Practice Advances Research Center Publications Psychiatry 2013 Patterns of Psychotherapy Attendance in Emerging and Mature Adults Maryann Davis University of Massachusetts Medical School Et al. Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/psych_cmhsr  Part of the Health Services Research Commons, Psychiatric and Mental Health Commons, Psychiatry Commons, Psychiatry and Psychology Commons, and the Psychoanalysis and Psychotherapy Commons Repository Citation Davis M, Fisher WH, Lidz CW, Gershenson B. (2013). Patterns of Psychotherapy Attendance in Emerging and Mature Adults. Implementation Science and Practice Advances Research Center Publications. Retrieved from https://escholarship.umassmed.edu/psych_cmhsr/620 This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Implementation Science and Practice Advances Research Center Publications by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. Patterns of Psychotherapy Attendance in Emerging and Mature AdultsINTRODUCTION•	 Approximately	760,000	emerging	adults	use	outpatient	psychotherapy	in	the	U.S.	each	year	(Olfson	et	al.,	2002).	•	 Emerging	adults		are	1.6-7.9	times	more	likely	to	drop	out	of	mental	health	treatment	than	fully	mature	adults	(Edlund	et	al.,	2002;	Olfson	et	al.,	2002).•	 This	study	compared	temporal	patterns	of	attendance	and	non	attendance	between	emerging	and	mature	adults.	METHODSSAMPLEThe	443	individuals	aged	16-55	who	initiated	individual	outpatient	psychotherapy		between	September	1	and	November	31,	2006	at	a	large	community	mental	health	center,		Community	Healthlink,	in	Worcester,	MA		DEPENDENT	VARIABLES:		 1.	The	total	number	of	sessions	in	18	months	 2.	The	number	of	sessions	per	month	for	each	of	the	18	months	INDEPENDENT	VARIABLES:		 1.	 Age Group. 	Emerging	Adults	=16-30	years,	Mature	Adults	=31-55	years		 2.	 Concurrent treatment.	Yes/No	for	outpatient	individual	substance			 		 	 abuse,	group	mental	health,	family	treatment,	medication	consult,		 	 		 	 between	1st	and	last		psychotherapy	session	 3. Background variables. 	 	 	 a.	 Gender	 	 	 b.	 Health	care	coverage	(Private	Insurance,	Public	Coverage,	none)	 	 	 c.	 Primary	diagnoses	of	record		 	 	 	 i.	 Schizophrenia	and	Bipolar	Disorder	(Schizophrenia	&	other		 		 	 	 	 	 psychotic	disorders	and	all	Bipolar	Disorders)	 	 	 	 ii.	 Affective	and	Anxiety	Disorders	(Major	Depressive	Disorder,	all			 	 	 	 	 other		mood	disorders,	&	all	Anxiety	disorders)	 	 	 	 iii.	 Other	disorders,	(Most	commonly	(78%)	adjustment	disorders)ANALYSIS:	 •	 Age	differences	analyzed	using	analysis	of	covariance	(using	repeated		 		 	 measures	for	monthly	session	attendance)	 •	 Temporal	patterns	were	analyzed	using	developmental	trajectory		 	 		 	 analysis	(Nagin	&	Land,	1993)Maryann	Davis,	PhD;	William	Fisher,	PhD;	Charles	Lidz,	PhD;	and	Bernice	Gershenson,	MPHIndependent Variables:♦	 Unique client identifier ♦	Therapist ID ♦	Gender ♦	Primary clinical diagnosis ♦	 Health care coverage source♦	Type of service provided♦	AgeDependent Variables:♦	 Service dates of all outpatient treatment for 78 weeks following initiation of individual psychotherapyTable	2.		Variables	extracted	from	de-identified	administrative	data	set	RESULTSTotal	number	of	sessions	attended	was	significantly	lower	in	Emerging	than	Mature	Adults13.15+1.09		vs.	17.73+1.03	(F(1,	432)=9.22,	p=.003).	DISCUSSION •	 Emerging Adults attend fewer psychotherapy sessions than mature adults,      independent of health care coverage type or diagnostic category.•	 There are different patterns of treatment desistance, which imply different treatment   retention efforts earlier and later in treatment.•	 Emerging adults are more likely than mature adults to display desisting patterns of    psychotherapy attendance.•	 There are likely important interactions of legal rights, parental influence, and      changing life circumstances that distinguish emerging adults who are legal adults    from those that are minors. CONCLUSIONS1. Emerging adults initiating psychotherapy would likely benefit from targeted efforts    to retain them in psychotherapy.2. Those targeted efforts would benefit from;  a. Research that identifies factors that could be the focus of interventions, that are     common and different between emerging and mature adults to help guide new     and adapted treatment emerging adult retention interventions b. Research that identifies malleable factors within emerging adults that distinguish    rapid and slower desisters to help guide treatment retention efforts early in      therapy from those later in therapy3. Identifying the factors that distinguish between desisting emerging adults who are    legal minors from legal adults may help identify unique treatment retention      issues faced by young adults on the threshold of adulthood that treatment retention   interventions for adolescents or generic adults may not address. REFERENCES	CITEDBarrett, M. S., Chua, W. J., Crits-Christoph, P., Gibbons, M. B., & Thompson, D. (2008). Early withdrawal from mental health treatment:   Implications for psychotherapy practice. Psychotherapy: Theory, Research, Practice, Training, 45(2), 247. Edlund, M.J, Wang, P.S., Berglund, P.A., Kats, S.J., Lin, E., & Kessler, R.C. (2002). Dropping out of mental health treatment: Patterns and   predictors among epidemiological survey respondents in the United States and Ontario. American Journal of Psychiatry 159: 845-   851. Olfson, M., Marcus, S., Druss, B., & Pinkus, H. (2002). National trends in the use of outpatient psychotherapy. American Journal of     Psychiatry, 159, 1914–1920.ACKNOWLEDGEMENTS:		This	research	was	funded	by	a	grant	from	the	National	Institute	of	Mental	Health	(RC1MH088542).	Grateful	thanks	to	David	Haddad	for	assistance	accessing	and	understanding	the	administrative	database,	and	leadership	at	Community	HealthLink	for	willingness	to	share	data.Table	1.	Baseline	characteristics	of	emerging	adults	(ages	16-30)	and	mature	adults	(ages	31-55)	in	a	sample	of	individuals	initiating	individual	psychotherapy	at	a	community	mental	health	center	(N=433)VariableEmerging Adults (N=205)Mature Adults (N=228)Total           (N=433)Participant CharacteristicsGender (%Male) 60.0% 56.6% 58.2%Diagnosis**Schizophrenia & Bipolar Disorders 21.9% 32.9% 27.3%Affective & Anxiety Disorders 43.4% 47.4% 45.5%Other Disorders 31.2% 10.1% 20.1%Payment method*Public: Medicaid, CHAMPUS, Medicare, State agency contract62.9% 76.8% 70.2%Private Insurance 22.9% 16.2% 19.4%Concurrent Services CharacteristicsMedication Consult** 47.8% 65.4% 57.0%Family/Couples Therapy ** 19.5% 7.5% 13.2%Group Therapy 5.9% 9.2% 7.6%SA Treatment* 2.4% 7.5% 5.1%***p<.001, **p<.01, *<.05 Figure	2.	Patterns of psychotherapy attendance in a community MH center. Three treatment persistence patterns; Low (13%), Moderate (19.4%), and High (6.2%). Two patterns of treatment desistence; Rapid (40.1%), and Slow (21.3%).Months of TreatmentFigure	1.		Age	differences	in	the	number	of	sessions	per	month,	while	covarying	diagnostic	group,	and	health	care	payor,	revealed	a	significant	month	by	age	group	interaction	(F	(17,413)=1.71,	p<.05).Months of TreatmentTable	3.		Age	Group	(emerging	vs.	mature	adults)	by	Therapy	Attendance	Pattern	group	differences	in	baseline	characteristics	and	treatment	variables	in	a	sample	of	individuals	initiating	individual	psychotherapy	at	a	community	mental	health	center	(N=433)Rapid Desisters Slower Desisters PersistersVariablesMature AdultsN=86Emerging AdultsN=87Mature AdultsN=37Emerging AdultsN=56Mature AdultsN=105Emerging AdultsN=62% Within Age Group ++ 37.7% 42.4% 16.2% 27.3% 46.1% 30.2%Total Sessions   Est. Marg. Means (SD)a3.94 (1.19) 3.28(1.16) 12.65(1.79) 14.43(1.47) 30.33(1.06) 26.64(1.38)Primary Diagnosis**††Schizophrenia or Bipolar 30.6% 17.1% 46.9% 14.5% 37.3% 35.6%Affective or Anxiety 51.4% 51.2% 53.1% 34.5% 52.4% 47.5%Other 18.1% 31.7% 0.00% 50.9% 11.2% 16.9%Health Care Coverage**†Public 72.3% 76.6% 100.0% 58.1% 85.4% 80.4%Private 27.7% 23.4% 0.0% 41.9% 17.5% 19.6%% Female 43.0% 35.6% 45.9% 39.3% 42.9% 46.8%Concurrent TreatmentGroup**† .0% 1.1% 13.5% 8.9% 15.2% 9.7%Substance Abuse+ 12.8% 4.6% 2.7% 1.8% 4.8% 0.00%Family ** ††† 2.3% 6.9% 2.7% 30.4% 13.3% 27.4%Medication Consult***††† 30.2% 24.3% 83.8% 64.5% 87.6% 86.8%In Emerging Adults Only    Est. Marg. Means (SD)Age in years 21.85 (0.48) 20.224(0.61) 21.37(0.57)Proportion Minorsb .223(.048) .410(.060) .284(.057)Trajectory	group	differences;	Age	group	Difference	++p<.01	 	 	 	 Trajectory	group	difference	(main	effect)	ap<.001	 	 	 	 within		Mature	Adults		+p=.053,**p<.01,	***p<.001	 	 	 	 within	Emerging	Adults	bp=.055,	†p<.05,	††p<.01,	†††p<.001

Patterns of Psychotherapy Attendance in Emerging and Mature Adults

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Patterns of Psychotherapy Attendance in Emerging and Mature Adults

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