Treatment Dropout Among Veterans and Their Families: Quantitative and Qualitative Findings

Doron Amsalem, Andrea Lopez-Yianilos, Ari Lowell, Alison M. Pickover, Shay Arnon, Xi Zhu, Benjamin Suarez-Jimenez, Matt Ryba, Maja Bergman, Sara Such, Hemrie Zalman, Arturo Sanchez-Lacay, Amit Lazarov, John C. Markowitz, Yuval Neria*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Psychotherapy noncompletion rates for veterans and their families are high. This study sought to (a) measure noncompletion rates of such patients at a university-based treatment center, (b) compare veteran and family member attrition rates, (c) identify dropout predictors, and (d) explore clinicians’ perspectives on treatment noncompletion. Method: Using quantitative and qualitative approaches, we analyzed demographic and clinical characteristics of 141 patients (90 military veterans; 51 family members) in a university treatment center. We defined dropout as not completing the time-limited therapy contract. Reviewing semistructured interview data assessing clinicians’ perspectives on their patients’ dropout, three independent raters agreed on key themes, with interrater coefficient kappa range.74 to 1. Results: Patient attrition was 24%, not differing significantly between veterans and family members. Diagnosis of major depression (MDD) and exposure-based therapies predicted noncompletion, as did higher baseline Hamilton Depression Rating Scale (HDRS) total scores, severe depression (HDRS. 20), lack of Beck Depression Inventory weekly improvement, and history of military sexual trauma. Clinicians mostly attributed noncompletion to patient difficulties coping with intense emotions, especially in exposure-based therapies. Conclusion: Noncompletion rate at this study appeared relatively low compared to other veteran-based treatment centers, if still unfortunately substantial. Patients with comorbid MDD/PTSD and exposure-based therapies carried greater noncompletion risk due to the MDD component, and this should be considered in treatment planning. Ongoing discussion of dissatisfaction and patient discontinuation, in the context of a strong therapeutic alliance, might reduce noncompletion in this at-risk population.

Original languageEnglish
Pages (from-to)578-586
Number of pages9
JournalPsychological Trauma: Theory, Research, Practice, and Policy
Issue number4
StatePublished - 16 Sep 2021


FundersFunder number
Acron Hill Foundation
New York-Presbyterian Hospital
New York-Presbyterian Hospital, Stand for the Troops Foundation
National Institute of Mental HealthK01MH122774
National Institute of Mental Health
Bob Woodruff Foundation
New York State Psychiatric InstituteK01 MH118428-01
New York State Psychiatric Institute


    • Depression
    • Dropout
    • Ptsd
    • Treatment
    • Veterans


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