Factors Associated with Treatment Dropout in Patients with Mood Disorders

Treatment dropout is common among patients with mood disorders and adversely affects long-term outcomes. This study investigated clinical and psychological factors associated with dropout, with a particular focus on stress coping strategies.

This retrospective cohort study included 321 patients with mood disorders who completed diagnostic evaluations and psychological assessments at a specialized mood disorder clinic between April 2010 and March 2021. Treatment dropout was defined as failure to attend scheduled outpatient appointments for more than 30 days without consultation, combined with no outpatient visit for at least 90 days.

Kaplan-Meier analyses showed significant differences in treatment retention according to diagnostic category. In univariate Cox analyses, younger age, diagnostic category, emotion-oriented coping, and pleasure-seeking activities were associated with dropout. In the clinically informed multivariable Cox model, younger age remained significantly associated with a higher hazard of dropout (hazard ratio = 0.987, 95% confidence interval = 0.976-0.999, p = 0.034). Diagnostic category was also significantly associated with dropout (Wald χ² = 25.433, df = 4, p < 0.001). Compared with bipolar I disorder, bipolar II disorder, other specified bipolar and related disorder, major depressive disorder, and other depressive disorders showed significantly higher hazards of dropout. Emotion-oriented coping and pleasure-seeking activities were no longer significant after adjustment.

Diagnostic category and younger age were the most robust factors associated with treatment dropout. Coping variables showed exploratory associations in univariate analyses, but these associations were attenuated after adjustment for demographic and clinical factors.