Dropout from outpatient mental health care in the United States

Psychiatr Serv. 2009 Jul;60(7):898-907. doi: 10.1176/appi.ps.60.7.898.


Objective: Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood. This study explored patterns and predictors of mental health treatment dropout in a nationally representative sample.

Methods: Data were from the National Comorbidity Survey Replication, a nationally representative household survey. Respondents who had received mental health treatment in the 12 months before the interview (N=1,664) were asked about dropout, which was defined as quitting treatment before the provider wanted them to stop. Cross-tabulation and discrete-time survival analyses were used to identify predictors.

Results: Approximately one-fifth (22%) of patients quit treatment prematurely. The highest dropout rate was from treatment received in the general medical sector (32%), and the lowest was from treatment received by psychiatrists (15%). Dropout rates were intermediate from treatment in the human services sector (20%) and among patients seen by nonpsychiatrist mental health professionals (19%). Over 70% of all dropout occurred after the first or second visits. Mental health insurance was associated with low odds of dropout (odds ratio=.6, 95% confidence interval=.4-.9). Psychiatric comorbidity was associated with a trend toward dropout. Several patient characteristics differentially predicted dropout across treatment sectors and in early and later phases of treatment.

Conclusions: Roughly one-fifth of adults in mental health treatment dropped out before completing the recommended course of treatment. Dropout was most common in the general medical sector and varied by patient characteristics across treatment sectors. Interventions focused on high-risk patients and sectors that have higher dropout rates will likely be required to reduce the large proportion of patients who prematurely terminate treatment.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Alcoholism / epidemiology
  • Alcoholism / psychology
  • Alcoholism / rehabilitation*
  • Ambulatory Care / statistics & numerical data*
  • Comorbidity
  • Complementary Therapies / statistics & numerical data
  • Cross-Sectional Studies
  • Ethnic Groups / psychology
  • Ethnic Groups / statistics & numerical data
  • Female
  • Health Surveys
  • Humans
  • Insurance, Psychiatric / statistics & numerical data
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / psychology
  • Mental Disorders / rehabilitation*
  • Middle Aged
  • Patient Care Team / statistics & numerical data
  • Patient Dropouts / statistics & numerical data*
  • Probability
  • Risk Factors
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / psychology
  • Substance-Related Disorders / rehabilitation*
  • United States
  • Young Adult