Dropping Out or Continuing Playing-A Case Study of Adolescent's Motives for Participation in Football

The purpose of this study was to investigate dropout and continuation motives among boys in youth football. Semi-structured interviews were conducted with all players from a former football team, consisting of 13 young people who were 17 years old when the in-depth interviews were conducted. Short interviews with the same players five years earlier (at the age of 12) were also included as part of the data. This strategy was used to gain a longitudinal perspective and a better insight into the participants' experience of organized football. Including in-depth data from all players at a football team-both players that dropped out and continued playing football, and also including some short interviews data from a longitudinal perspective, this study bring new findings into the discussion about sport participation. When the in-depth interviews were conducted, six of the participants had dropped out of football, while seven were still active. The results show that social factors, ambition, other interests and differences in skill and physical development, were all reasons for dropout from this team. Among those who continued playing football, the social aspect of football, their love for the sport, competitive instinct and the training benefits the sport provided, were reasons they continued playing. Furthermore, the findings showed that those who reported the lowest ambitions at the age of twelve, had dropped out of football, while the one with the highest ambitions had continued playing football. Our findings indicate that ambition can be a crucial factor in relation to participation in football, and also that the social aspect of football is an important motivational factor that coaches and parents should be aware of.

Attrition in the Gothenburg H70 birth cohort studies, an 18-year follow-up of the 1930 cohort

Background

Longitudinal studies are essential to understand the ageing process, and risk factors and consequences for disorders, but attrition may cause selection bias and impact generalizability. We describe the 1930 cohort of the Gothenburg H70 Birth Cohort Studies, followed from age 70 to 88, and compare baseline characteristics for those who continue participation with those who die, refuse, and drop out for any reason during follow-up.

Methods

A population-based sample born 1930 was examined with comprehensive assessments at age 70 (N = 524). The sample was followed up and extended to increase sample size at age 75 (N = 767). Subsequent follow-ups were conducted at ages 79, 85, and 88. Logistic regression was used to analyze baseline characteristics in relation to participation status at follow-up.

Results

Refusal to participate in subsequent examinations was related to lower educational level, higher blood pressure, and lower scores on cognitive tests. Both attrition due to death and total attrition were associated with male sex, lower educational level, smoking, ADL dependency, several diseases, poorer lung function, slower gait speed, lower scores on cognitive tests, depressive symptoms, and a larger number of medications. Attrition due to death was also associated with not having a partner.

Conclusions

It is important to consider different types of attrition when interpreting results from longitudinal studies, as representativeness and results may be differently affected by different types of attrition. Besides reducing barriers to participation, methods such as imputation and weighted analyses can be used to handle selection bias.

Perceived parental alcohol problems and later dropout and grade point average in high school: A register-based follow-up study

INTRODUCTION

The aim of the study was to test the hypothesis that young people with perceived parental alcohol problems have higher dropout rates in high school and lower grade point average (GPA) at graduation compared to young people without perceived parental alcohol problems.

METHODS

Data come from Danish National Youth Study 2014 (n = 62,171), merged with register-data on later dropout of high school and GPA. Multilevel Poisson regression models of incidence rates of dropout and multilevel linear models of GPA were used to assess the association with perceived parental alcohol problems.

RESULTS

A total of 6.6% of the students perceived their parent(s) to have alcohol problems. Young people with perceived parental alcohol problems had higher dropout rate (girls incidence rate ratio 1.83; 95% confidence interval [1.62-2.06]); boys (incidence rate ratio 1.38; 95% confidence interval [1.17-1.64]) and lower grades (GPA: -0.24; 95% confidence interval [-0.32; -0.17]) compared to those without. There was no statistically significant difference between mother's and fathers' alcohol problems in the associations with dropout and GPA.

DISCUSSION AND CONCLUSIONS

Perceived parental alcohol problems were associated with higher incidence rate ratio of dropout and lower grades within all categories of the socioeconomic factors. Our results show that young people with perceived parental alcohol problems have higher high school dropout rates and lower grades compared to those without perceived parental alcohol problems across gender and socioeconomic position. The results call for evidence-based interventions to support young people with parental alcohol problems in the educational system.

Process-outcome relations in music therapy versus music listening for people with schizophrenia viewed through a mediational model: the role of the therapeutic alliance

Objectives

Examine whether change in clinical outcomes for patients with schizophrenia and negative symptoms randomized to either Music Therapy (MT) or Music Listening (ML) is associated to moderators and mediators, with focus on alliance, attendance and dropout.

Method

An exploratory post-hoc analysis of data from an original randomized controlled trial (RCT) investigating the effect of MT vs. ML for people with schizophrenia and negative symptoms. Inclusion to the study was implemented through screening of referred patients for symptoms of schizophrenia and negative symptoms. A total of 57 patients were randomly assigned, 28 to MT and 29 to ML. Session logs and notes were included in this study. Statistical analysis investigated moderator and mediator relation to outcome variables: Negative symptoms, functioning, quality of life, and retention to treatment.

Results

On average, participants in MT attended 18.86 sessions (SD = 7.17), whereas those in ML attended 12.26 (SD = 9.52), a statistically significant difference (p = 0.0078). Dropout at 25 weeks was predicted by intervention, with dropout being 2.65 (SE = 1.01) times more likely in ML than in music therapy (p = 0.009). Helping alliance score at weeks was explained by intervention, with mean score being 0.68 (SE = 0.32) points lower in ML than in MT (p = 0.042). The number of sessions attended was also explained by intervention, with participants in ML attending on average 6.17 (SE = 2.24) fewer sessions than those randomized to MT (p = 0.008). Though both groups improved significantly, improvements in negative symptoms, depression, and functioning tended to be higher in ML, whereas improvements in alliance and quality of life tended to be higher in MT.

Conclusion

The analysis could not detect a direct link between helping alliance score and outcome variables. However, the analysis documented a stronger alliance developed in the MT group, a lower dropout rate, as well as higher attendance in treatment.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02942459.

Characteristics of patients who dropped out after multidisciplinary pain management in Japan: A prospective cohort study

BACKGROUND

Because regular visits to distant hospitals may be a burden to patients, both in terms of time and cost, some patients with chronic musculoskeletal pain may discontinue multidisciplinary pain treatment, unable to maintain motivation to attend.

OBJECTIVE

To evaluate and compare the pre-program characteristics of patients who dropped out and patients who continued treatment, thereby clarifying the characteristics of patients at risk of dropping out.

METHODS

A multidisciplinary pain management treatment program was implemented for patients at the Pain Management Center, Hoshi General Hospital. From April 2015 to March 2018, 23 patients participated in the program. Twelve of the 23 patients lived outside the prefecture where the hospital is located. Of these 12 patients, five completed the program, while seven did not. We compared the dropout and continuation groups in terms of patient characteristics, pain severity, pain-related psychosocial factors, and quality of life.

RESULTS

We found significant differences (p< 0.05) in median age, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire walking ability dysfunction score, and Roland-Morris Disability Questionnaire score.

CONCLUSIONS

The characteristics of patients who dropped out were older age, walking ability dysfunction, and low quality of life associated with low back pain.

Predicting patients who will drop out of out-patient psychotherapy using machine learning algorithms

BACKGROUND

About 30% of patients drop out of cognitive-behavioural therapy (CBT), which has implications for psychiatric and psychological treatment. Findings concerning drop out remain heterogeneous.

AIMS

This paper aims to compare different machine-learning algorithms using nested cross-validation, evaluate their benefit in naturalistic settings, and identify the best model as well as the most important variables.

METHOD

The data-set consisted of 2543 out-patients treated with CBT. Assessment took place before session one. Twenty-one algorithms and ensembles were compared. Two parameters (Brier score, area under the curve (AUC)) were used for evaluation.

RESULTS

The best model was an ensemble that used Random Forest and nearest-neighbour modelling. During the training process, it was significantly better than generalised linear modelling (GLM) (Brier score: d = -2.93, 95% CI (-3.95, -1.90)); AUC: d = 0.59, 95% CI (0.11 to 1.06)). In the holdout sample, the ensemble was able to correctly identify 63.4% of cases of patients, whereas the GLM only identified 46.2% correctly. The most important predictors were lower education, lower scores on the Personality Style and Disorder Inventory (PSSI) compulsive scale, younger age, higher scores on the PSSI negativistic and PSSI antisocial scale as well as on the Brief Symptom Inventory (BSI) additional scale (mean of the four additional items) and BSI overall scale.

CONCLUSIONS

Machine learning improves drop-out predictions. However, not all algorithms are suited to naturalistic data-sets and binary events. Tree-based and boosted algorithms including a variable selection process seem well-suited, whereas more advanced algorithms such as neural networks do not.

Determinants of Dropout from and Variation in Adherence to an Exercise Intervention: The STRRIDE Randomized Trials

Purpose

This study aimed to characterize the timing and self-reported determinants of exercise dropout among sedentary adults with overweight or obesity. We also sought to explore variations in adherence among individuals who completed a 6- to 8-month structured exercise intervention.

Methods

A total of 947 adults with dyslipidemia [STRRIDE I, STRRIDE AT/RT] or prediabetes [STRRIDE-PD] were enrolled to either control or to one of 10 exercise interventions, ranging from doses of 8-23 kcal/kg/week; intensities of 50%-75% V̇O2 peak; and durations of 6-8 months. Two groups included resistance training and one included dietary intervention (7% weight loss goal). Dropout was defined as an individual who withdrew from the study due a variety of determinants. Timing of intervention dropout was defined as the last session attended and categorized into phases. Exercise training adherence was calculated by dividing weekly minutes or total sets of exercise completed by weekly minutes or total sets of exercise prescribed. General linear models were used to characterize the associations between timing of dropout and determinant category.

Results

Compared to exercise intervention completers (n=652), participants who dropped out (n=295) were on average non-white (98% vs. 80%, p<0.01), had higher body mass index (31.0 kg/m2 vs. 30.2 kg/m2; p<0.01), and were less fit at baseline (25.0 mg/kg/min vs. 26.7 ml/kg/min, p<0.01). Of those who dropped out, 67% did so prior to the start of or while ramping up to the prescribed exercise volume and intensity. The most commonly reported reason for dropout was lack of time (40%). Notably, among individuals who completed the ramp training period, subsequent exercise intervention adherence did not waiver over the ensuing 6-8 months of training.

Conclusion

These findings are some of the first to delineate associations between the timing of dropout and dropout determinants, providing guidance to future exercise interventions to better support individuals at-risk for dropout.

Role of maintenance treatment on long-term efficacy of bilateral iTBS of the prefrontal cortex in treatment-seeking cocaine addicts: A retrospective analysis

CUD, like other addictions, is a chronic disease characterized by a high rate of relapse and drop-out (DO) from medical and behavioral treatment programs, which is positively correlated with relapse. Repetitive transcranial Magnetic Stimulation (rTMS) protocols have shown therapeutic potential in addiction in the short term, but only a few studies have explored their long-term efficacy, so far. This study explores the long-term outcome of bilateral intermittent theta-burst stimulation (iTBS) of the prefrontal cortex (PFC) in cocaine use disorder (CUD) and the possible influence of maintenance treatment in improving abstinence and decreasing DO rates. Eighty-nine treatment-seeking CUD patients were exposed to 20 sessions of iTBS. At the end of the treatment 61 (81%) abstinent patients underwent a 12 months follow-up. Among these, 27 patients chose to follow a maintenance treatment (M), whereas 34 patients chose not to adhere to a maintenance treatment (NM). Overall, among patients reaching the 12 months follow-up endpoint, 69.7% were still abstinent and 30.3% relapsed. In NM-patients the DO rate was significantly higher than in M-ones (58.82 vs. 29.63%). The present observations show the long-term therapeutic effect of bilateral PFC iTBS to decrease cocaine consumption. Moreover, they underline the importance to perform a maintenance protocol to consolidate abstinence and decrease DO rates over time.

Who will drop out of voluntary social health insurance? Evidence from the New Cooperative Medical Scheme in China

Although public voluntary health insurance (VHI) has been adopted in many low- and middle-income countries to improve access to care for the population, a common issue with VHI is its high dropout rate. Using the New Cooperative Medical Scheme (NCMS)-a public VHI in China-as a case study, this article employs a fixed-effects negative binomial regression model combining the difference-in-difference-in-differences approach and multivariate distance matching to examine the factors associated with dropping out and the impact of dropout on outpatient care utilization among middle-aged and older people in rural China. Drawing data from the China Health and Retirement Longitudinal Study, our results showed that healthy people, vulnerable people and people who use less healthcare tended to drop out. Dropout had a significant negative impact on outpatient care utilization, especially for those with worse health statuses and those living in poorer provinces. We also found that the impact of dropout on outpatient utilization was more pronounced at secondary and tertiary hospitals than at primary care clinics. We urge policymakers to rethink the design of the NCMS by waiving premiums for the most vulnerable people.

The Role of Personality Functioning on Early Drop out in Outpatient Substance Misuse Treatment

Treatment initiation is a major factor contributing to positive outcomes, but the supporting literature remains limited. It is difficult to draw conclusions regarding predictors of dropout, and there is a need to target clients' major early attrition vulnerabilities. Despite empirically validated models for assessing personality, little is known about its role in the treatment process. Studies that have been conducted in this area have focused mainly on stable personality traits and provide conflicting evidence. Aims: The aim of this study is to examine to what extent service users' personality functioning are potential determinants of early drop out. Methodology: A cross-sectional multi-site design examined the therapy process in a naturalistic setting in 5 outpatient preparation treatment centers with 210 service users. The current study adopts a contemporary dimensional-based framework, similar to the Alternative Model of Personality Disorder of the DSM-V and examines the role of characteristic adaptations (SIPP-118) on early drop out (CEST-Intake). Findings: From the broad spectrum of personality traits, only Depression remained significant predictor of drop out. Higher dysfunctional levels in Social Concordance [OR] = 1.85, Wald =19.87, p =.002, 95% CI [1.1, 1.9] as well as the facets Aggression Regulation, Respect and Purposefulness were also predictors of early drop out, while Treatment Readiness and Desire for Help accounted for a significant amount of variance. Conclusions: These findings extend our knowledge of the predictive role of characteristic adaptations in treatment and suggest it may be important to assess these individual differences early on and to design personalized-informed interventions.

A Longitudinal Study

Several studies indicate that participation in organized sport may result in higher physical activity levels among youth which are associated with high levels of cardiorespiratory fitness. However, no study has examined whether cardiorespiratory fitness (VO_2peak) is associated with drop out from sport. The study was a 5-year longitudinal study which followed a sample of adolescents, with measures of cardiorespiratory fitness, weight and height between the age of 14 and 19 yrs. Self-reported data about participation in sport, active commuting and physical activity level were also included. Through logistic regression analyses we found a positive association between cardiorespiratory fitness at the age of 14 years and participation in organized sport at the age of 19. However, no significant associations were found between physical activity (PA) level, overweight, gender and active commuting to school at the age of 14, and participation in organized sport at the age of 19. We argue that a high level of cardiorespiratory fitness may increase the probability for experiencing high levels of enjoyment, competence and performance in sport, because sport participation requires a certain level of cardiorespiratory fitness. The findings indicates the importance of removing barriers, and to increase access and design of sport programs of interest to youth in the contexts in which they live, attract adolescents with different levels of ambition and abilities in sport. Further studies should include longitudinal studies among young children, and their drop out patterns from sport during adolescence.

Effect of Early Grade Retention on School Completion: A Prospective Study

This 14 year prospective study investigated the effect of retention in grades 1-5 on high school completion (diploma, GED, or drop out). Participants were 734 (52.7% males) ethnically diverse, academically at-risk students recruited from Texas schools into the study when they were in first grade (mean age = 6.57). Propensity score weighting successfully equated the 256 retained students and the 478 students continuously promoted students on 65 covariates assessed in grade 1. At the end of 14 years, 477 had earned a diploma, 21 had obtained a GED, 110 had dropped out, and 126 were missing school completion status. Using multinomial logistic regression with high school graduation as the reference outcome, retention led to a significant increase in the likelihood of dropping out of high school (odds ratio = 2.61), above students' propensity to be retained and additional covariates. The contrast between graduation and GED outcomes was not significant. A significant Retention X Ethnicity X Gender interaction was obtained: The negative effect of retention was strongest for African American and Hispanic girls. Even though grade retention in the elementary grades does not harm students in terms of their academic achievement or educational motivation at the transition to high school, retention increases the odds that a student will drop out of school before obtaining a high school diploma.

Predictors of premature termination from psychotherapy for anorexia nervosa: Low treatment credibility, early therapy alliance, and self-transcendence

OBJECTIVE

Failure to complete treatment for anorexia nervosa (AN) is- common, clinically concerning but difficult to predict. This study examines whether therapy-related factors (patient-rated pretreatment credibility and early therapeutic alliance) predict subsequent premature termination of treatment (PTT) alongside self-transcendence (a previously identified clinical predictor) in women with AN.

METHODS

56 women aged 17-40 years participating in a randomized outpatient psychotherapy trial for AN. Treatment completion was defined as attending 15/20 planned sessions. Measures were the Treatment Credibility, Temperament and Character Inventory, Vanderbilt Therapeutic Alliance Scale and the Vanderbilt Psychotherapy Process Scale. Statistics were univariate tests, correlations, and logistic regression.

RESULTS

Treatment credibility and certain early patient and therapist alliance/process subscales predicted PTT. Lower self-transcendence and lower early process accounted for 33% of the variance in predicting PTT.

DISCUSSION

Routine assessment of treatment credibility and early process (comprehensively assessed from multiple perspectives) may help clinicians reduce PTT thereby enhancing treatment outcomes.

A Systematic Review of Evidence on the Use of Very Low Calorie Diets in People with Diabetes

BACKGROUND

Recent interest has emerged regarding the effects of Very Low Calorie Diet (VLCD) in people with type 2 diabetes (T2D). We therefore performed a systematic review to investigate the effects of VLCD on HbA1c, weight and cardiovascular risk profile outcomes as well as its safety and tolerability among people with T2D.

METHODS

We conducted searches of Cochrane Database of Systematic Reviews, Centre for reviews and Dissemination databases, Medline, Embase, Pubmed, Web of Science, Web of Knowledge and Turning Research into Practice (TRIP) as well as ongoing trial resources. We included all studies involving VLCD and diabetes published until December 2013. Outcome measures include weight, HbA1c, fasting glucose, fasting insulin, lipid profile, blood pressure, safety and drop out rates.

RESULTS

17 studies were included in the systematic review. Duration of VLCD duration ranged from 5 days to 6 months and duration of follow up ranged from 8 days to 5 years. The age range was 14 years to 59 years of age. Mean weight loss was 13.2kg, ranging from 4.1 to 24kg. Mean Hba1c reduction was 1.4% (ranging between 0.1 to 3.1% reduction across different studies). Three studies reported a significant reduction in the daily doses of insulin. All studies which reported cardiovascular risk profile showed a significant decrease in total cholesterol, systolic and diastolic blood pressure post VLCD. Apart from two studies, all of the other studies showed that the decrease in blood pressure and total cholesterol was not only present immediately post VLCD, but it was also maintained at follow up. However it is important to note that the follow up periods did differ between studies. Overall, drop out rates ranged from 4.7% to 33% and appeared to be lower during the active intervention phase compared with during the follow-up period. No major adverse event was reported apart from one study which recorded a non-fatal myocardial infarction.

CONCLUSION

This review demonstrated that VLCD in people with T2D was associated with significant weight loss, reduction in blood glucose profile and improvement in cardiovascular risk profile, high tolerability and good safety outcomes. Studies were heterogeneous and longer term outcomes data post VLCD is still required.

Immediate drop-out rate in adolescent substance abusers: an out-patient chart review from North India

INTRODUCTION

Although a number of management strategies are available for adolescent substance abusers, the outcomes are limited due to high drop out. The factors related to drop out in adolescent substance users, especially in low and middle income countries (LAMIC) have been sparsely studied.

OBJECTIVE

To study the personal, family and clinical variables related to immediate drop out in adolescent substance abusers.

MATERIALS AND METHODS

A retrospective outpatient chart review was carried out for adolescent substance abusers aged 12-19 years from January 2012 to December 2014.

RESULTS

Of the 89 patients, 57 (64%) dropped out immediately. The majority of adolescent substance users were >17 years (85%), having some education (90%), belonging to a joint family (76%), having good family support (66%). Drop out was higher in those with later onset and less duration of substance abuse (3.42 vs. 2.36, p=0.014), not currently employed/attending school (OR=2.65, 95% CI=1.04-6.70), not having a psychiatric comorbidity, using a single substance and abusing cannabis. Factors like school drop out, background, family type and support and the relationship to the accompanying person were not associated with immediate drop out.

CONCLUSION

Later onset, lesser duration of substance use, not currently employed/attending school, absence of psychiatric illness and using cannabis were associated with drop out from outpatient treatment. These factors must be thoroughly addressed in substance abuse interventions.

HIV Patients Drop Out in Indonesia: Associated Factors and Potential Productivity Loss

AIM

this study reported various factors associated with a higher probability of HIV patients drop out, and potential productivity loss due to HIV patients drop out.

METHODS

we analyzed data of 658 HIV patients from a database in a main referral hospital in Bandung city, West Java, Indonesia from 2007 to 2013. First, we utilized probit regression analysis and included, among others, the following variables: patients' status (active or drop out), CD4 cell count, TB and opportunistic infection (OI), work status, sex, history of injecting drugs, and support from family and peers. Second, we used the drop out data from our database and CD 4 cell count decline rate from another study to estimate the productivity loss due to HIV patients drop out.

RESULTS

lower CD4 cell count was associated with a higher probability of drop out. Support from family/peers, living with family, and diagnosed with TB were associated with lower probability of drop out. The productivity loss at national level due to treatment drop out (consequently, due to CD4 cell count decline) can reach US$365 million (using average wage).

CONCLUSION

first, as lower CD 4 cell count was associated with higher probability of drop out, we recommend (to optimize) early ARV initiation at a higher CD 4 cell count, involving scaling up HIV service at the community level. Second, family/peer support should be further emphasized to further ensure treatment success. Third, dropping out from ART will result in a relatively large productivity loss.

Attendance Behavior of Ex-members in Fitness Clubs: A Retrospective Study Applying the Stages of Change

The transtheoretical model of behavior change (TTM) is often used to understand and predict health-related behavior. The objective of this study is to apply the TTM's stages of change to examine patterns of attendance behavior at fitness clubs. A retrospective study was performed to study the later stages of change, using attendance data of members who cancelled their membership in 2012 in two European fitness chains, including 259,355 ex-members of 267 clubs. A sample of 400 was selected at random for analyses, M age = 32.1 yr. (SD = 10.9; 64% males) and 34.7 yr. (SD = 11.0; 51% males) for BasicFit and HealthCity. Regular attendance behavior was defined by at least four visits per month. In the past, all ex-members had purchased a membership and by that were considered to have entered the preparation stage, but 19.5% had never attended the club in 24 months. Of the ex-members, 10% demonstrated regular attendance behavior for six months, and 2.3% had regular attendance for 24 months. 49% did not attend the club for one full month but started regular attendance again. Significant positive correlations were found in attendance behavior between the 6th and 12th months (r = .61), and the 12th and 24th months (r = .45), suggesting that ex-members who attended for more than six months were more likely to have maintained their attendance behavior. With only 10% of the members demonstrating regular attendance behavior, it is evident that appropriate strategies have to be developed to improve attendance behavior and facilitate exercise behavior in fitness clubs.

Service Engagement in First-Episode Psychosis: Current Issues and Future Directions

It has been reported that up to 50% of patients receiving mental health services disengage from treatment, with adolescents and young adults being particularly at high risk. Even in the context of specialized services in youth mental health, such as early intervention programs for psychosis, disengagement rates remain high. There is a need for extensive and innovative efforts to address the issue of service disengagement in first-episode psychosis (FEP). A multi-dimensional understanding of the phenomenon of engagement can help to inform the development of strategies to address this important clinical issue. In our paper, we propose a conceptual framework for understanding service engagement, provide an overview of the issues pertaining to service engagement in FEP, and suggest future directions for research and practice.

Why do couples discontinue unlimited free IVF treatments?

Worldwide, IVF is often discontinued before a live birth is achieved due to high costs. Even when partial financial coverage is provided, often medical providers advise treatment discontinuation. In Israel, unlimited IVF is offered free of charge for a couples' first two children. Our objective was to assess the reasons couples discontinue IVF treatments before achieving two children in a completely unlimited cost-free environment. This cohort study included all primary infertile women, <35 years, referred for their first IVF cycle to Sheba IVF unit between 2001 and 2002. Patients were followed until February 2012. Those who ceased treatments for 12 months were interviewed to assess the main reason they ceased treatments. Of the 134 couples included, only 46 ceased IVF treatments without achieving two children, after performing an average of 6.2 IVF cycles to achieve their first birth. The reasons given were: lost hope of success (13), psychological burden (18), divorce (6), medical staff recommendation (5), bureaucratic difficulties (3) and general medical condition (1). The main reasons for "drop out" in our cost-free environment were as follows: psychological burden and lost hope of success. Due to high availability of treatments, medical staff recommendation was a less significant factor in our study.

Periloss dissociation, symptom severity, and treatment response in complicated grief

BACKGROUND

Complicated grief (CG) is a bereavement-specific syndrome characterized by traumatic and separation distress lasting over 6 months. Little is known about the role of dissociation experienced during or immediately after the loss of a loved one (i.e., periloss dissociation [PLD]) in CG. The present study aimed to examine the psychometric properties of the PLD-adapted Peritraumatic Dissociative Experiences Questionnaire and its association with symptom severity, treatment response, and drop-out rate.

METHODS

PLD data collected as part of a randomized controlled trial of two loss-focused psychotherapy approaches for CG were examined. Treatment-seeking individuals with primary CG (n = 193) were assessed for PLD at the initial visit, 95 of whom were randomized and completed at least one treatment session.

RESULTS

The PLD-adapted Peritraumatic Dissociative Experiences Questionnaire was found to be internally consistent (α = 0.91) with good convergent and divergent validity. After controlling for age, gender, time since loss, and current comorbid psychiatric diagnosis, self-reported PLD was associated with greater CG symptom severity (P < .01). However, contrary to our hypotheses, after controlling for age, baseline symptoms severity, psychiatric comorbidity, and treatment arm, PLD was predictive of better treatment response (P < .05) and lower study discontinuation (P < .01).

CONCLUSIONS

PLD may be useful in identifying individuals at risk for CG and those who might respond to psychotherapy. Additional research should investigate the relationship of PLD with treatment outcome for different treatment approaches, and whether PLD prospectively predicts the development of CG.

Analysis of patients attending a private psychiatric clinic

BACKGROUND

Private psychiatric clinics provide help for the bulk of our population, but they have not been evaluated systematically. It is time that we analyze the functioning of these set-ups to improve functioning. This paper is a modest attempt to analyze one such clinic.

AIMS

To analyze the diagnostic distribution of the clients attending the clinic and to study the pattern of follow-up.

MATERIALS AND METHODS

All records from April 1(st) 1997 to 31(st) March 1999 were analyzed. This is a descriptive study.

RESULTS AND CONCLUSIONS

A total of 3077 new patients visited the clinic in this period. The male:female ratio was 54:46. Diagnostic distribution revealed the following: schizophrenia 20%, affective disorders 40%, OCD 8%, dissociative disorders 5.5% and anxiety disorders around 4.5%. The pattern of visits revealed that 50% of the patients dropped out after the first visit. Another 25% did so in next the two visits.