Barriers to attending initial psychological therapy service appointments for common mental health problems: A mixed-methods systematic review

Jennifer Sweetman; Peter Knapp; Danielle Varley; Rebecca Woodhouse; Dean McMillan; Peter Coventry

doi:10.1016/j.jad.2021.01.089

Barriers to attending initial psychological therapy service appointments for common mental health problems: A mixed-methods systematic review

J Affect Disord. 2021 Apr 1:284:44-63. doi: 10.1016/j.jad.2021.01.089. Epub 2021 Feb 5.

Authors

Jennifer Sweetman¹, Peter Knapp², Danielle Varley³, Rebecca Woodhouse³, Dean McMillan², Peter Coventry³

Affiliations

¹ Department of Health Sciences, University of York, UK. Electronic address: jennifer.sweetman@york.ac.uk.
² Department of Health Sciences, University of York, UK; Hull York Medical School, UK.
³ Department of Health Sciences, University of York, UK.

PMID: 33582432
DOI: 10.1016/j.jad.2021.01.089

Abstract

Background: Non-attendance at initial appointments is a widespread problem which affects mental health services and patients.

Methods: This mixed methods systematic review identified and synthesised the available literature on factors, which could be modified either by patients or by services, that can influence early attrition to services offering psychological support for common mental health problems. Searches were conducted January 2017, updated Oct 2019, in MEDLINE, CINAHL Plus, EMBASE, Cochrane Library and PsycINFO. Screening, data extraction and quality appraisal were completed independently by two reviewers. Quality appraisals used Joanna Briggs Institute tools.

Results: Of the 31,758 references identified (21,123 unique), 34 studies were selected for inclusion. Studies used cohort (14), cross-sectional (10) and qualitative (9) designs. An additional study reported both quantitative and qualitative components. Findings from observational studies related to the presenting problem, beliefs about symptoms and treatment, contact with services, practical challenges and social support. Themes from qualitative studies centred around individual perceptions of symptoms and support, social and cultural influences, experiences with services and practical issues. Similarities and differences between quantitative and qualitative syntheses are discussed in a combined synthesis.

Limitations: This review did not attempt to measure the effect of factors affecting attendance, or the effectiveness of interventions to reduce non-attendance to initial treatment appointments.

Conclusions: Ensuring treatments offered matched patient perceptions of problems, reducing patient concerns around engagement, and offering prompt responses with flexibility to accommodate patient circumstances consistently influenced initial attendance. More work is needed to improve perceptions of mental health services in the community.

Keywords: Common mental disorders; Non-attendance; Psychological therapy; Systematic review.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Cross-Sectional Studies
Humans
Mental Health*
Qualitative Research
Social Support*