Factors Influencing Treatment Dropout Among Child and Adolescent Psychiatric Patients: A Survival Analysis

Child and adolescent mental health disorders are a significant global health concern, with high rates of treatment dropout adversely affecting long-term outcomes. This retrospective cohort study aimed to identify factors influencing treatment dropout in child and adolescent psychiatric patients. 443 outpatients aged < 15 years who visited a specialized child and adolescent psychiatry outpatient clinic at a national medical center in Japan between April 2022 and March 2023 were followed for 1 year. Dropout was defined as failure to attend scheduled appointments without notice or having no record of visits for more than 6 months after the last visit. Of the 443 patients, 74 (16.7%) dropped out within 1 year. Parental divorce or separation increased dropout risk (odds ratio [OR] = 2.28, 95% confidence interval [CI]: 1.05-5.10, p < 0.05), whereas receiving a prescription at the initial visit decreased risk (OR = 0.27, 95% CI: 0.10-0.76, p < 0.05; hazard ratio = 0.28, 95% CI: 0.12-0.65, p < 0.01). The Kaplan-Meier analysis revealed higher 1-year retention rates for patients receiving initial prescriptions (93 vs. 79%), particularly among females (98 vs. 79%). Early pharmacological interventions and identification of high-risk family constellations may enhance treatment retention in child and adolescent psychiatry.