Predictors of treatment dropout in patients with posttraumatic stress disorder due to childhood abuse

Background Knowledge about patient characteristics predicting treatment dropout for post-traumatic stress disorder (PTSD) is scarce, whereas more understanding about this topic may give direction to address this important issue. Method Data were obtained from a randomized controlled trial in which a phase-based treatment condition (Eye Movement Desensitization and Reprocessing [EMDR] therapy preceded by Skills Training in Affect and Interpersonal Regulation [STAIR]; n = 57) was compared with a direct trauma-focused treatment (EMDR therapy only; n = 64) in people with a PTSD due to childhood abuse. All pre-treatment variables included in the trial were examined as possible predictors for dropout using machine learning techniques. Results For the dropout prediction, a model was developed using Elastic Net Regularization. The ENR model correctly predicted dropout in 81.6% of all individuals. Males, with a low education level, suicidal thoughts, problems in emotion regulation, high levels of general psychopathology and not using benzodiazepine medication at screening proved to have higher scores on dropout. Conclusion Our results provide directions for the development of future programs in addition to PTSD treatment or for the adaptation of current treatments, aiming to reduce treatment dropout among patients with PTSD due to childhood abuse.

[1]  N. Morina,et al.  Are psychological interventions for adult PTSD more efficacious and acceptable when treatment is delivered in higher frequency? A meta-analysis of randomized controlled trials. , 2023, Journal of anxiety disorders.

[2]  M. Kindt,et al.  Imagery Rescripting as a stand-alone treatment for posttraumatic stress disorder related to childhood abuse: A randomized controlled trial. , 2022, Journal of behavior therapy and experimental psychiatry.

[3]  R. Huntjens,et al.  Phase-based treatment versus immediate trauma-focused treatment for post-traumatic stress disorder due to childhood abuse: randomised clinical trial , 2021, BJPsych Open.

[4]  Fariha Sohil,et al.  An introduction to statistical learning with applications in R , 2021, Statistical Theory and Related Fields.

[5]  R. DeRubeis,et al.  The promise of machine learning in predicting treatment outcomes in psychiatry , 2021, World psychiatry : official journal of the World Psychiatric Association.

[6]  R. Bryant,et al.  Dropout from guideline-recommended psychological treatments for posttraumatic stress disorder: A systematic review and meta-analysis , 2021 .

[7]  M. Cloitre,et al.  Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial , 2021, European journal of psychotraumatology.

[8]  G. Lipinska,et al.  Evidence of distinct profiles of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD in a South African sample , 2020, European journal of psychotraumatology.

[9]  R. DeRubeis,et al.  Cross-trial prediction in psychotherapy: External validation of the Personalized Advantage Index using machine learning in two Dutch randomized trials comparing CBT versus IPT for depression , 2020, Psychotherapy research : journal of the Society for Psychotherapy Research.

[10]  J. Bisson,et al.  Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis , 2020, European journal of psychotraumatology.

[11]  N. Welton,et al.  Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis , 2020, Psychological Medicine.

[12]  Z. Cohen,et al.  A demonstration of a multi-method variable selection approach for treatment selection: Recommending cognitive–behavioral versus psychodynamic therapy for mild to moderate adult depression , 2020, Psychotherapy research : journal of the Society for Psychotherapy Research.

[13]  L. Berman A clinical example , 2019, Beyond the smile.

[14]  P. Hyland,et al.  Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis , 2019, Psychological Medicine.

[15]  Ronald C. Kessler,et al.  Sample Size Requirements for Multivariate Models to Predict Between-Patient Differences in Best Treatments of Major Depressive Disorder , 2019, Clinical Psychological Science.

[16]  S. Bussadori,et al.  Effect of LED therapy for the treatment nipple fissures , 2018, Medicine.

[17]  R. Huntjens,et al.  Phase-based treatment versus immediate trauma-focused treatment in patients with childhood trauma-related posttraumatic stress disorder: study protocol for a randomized controlled trial , 2018, Trials.

[18]  Marthe C. Hoofwijk,et al.  Development and Evaluation of the Dutch Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) , 2018, European journal of psychotraumatology.

[19]  A. Jongh,et al.  Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder , 2018, European journal of psychotraumatology.

[20]  M. Delgado-Rodríguez,et al.  Systematic review and meta-analysis. , 2017, Medicina intensiva.

[21]  P. Schnurr,et al.  The Clinician-Administered PTSD Scale for DSM–5 (CAPS-5): Development and Initial Psychometric Evaluation in Military Veterans , 2017, Psychological assessment.

[22]  Fei Tang,et al.  Random forest missing data algorithms , 2017, Stat. Anal. Data Min..

[23]  Randon S. Welton,et al.  Benzodiazepines for PTSD: A Systematic Review and Meta-Analysis , 2015, Journal of psychiatric practice.

[24]  Max Kuhn,et al.  Applied Predictive Modeling , 2013 .

[25]  Zac E. Imel,et al.  Meta-analysis of dropout in treatments for posttraumatic stress disorder. , 2013, Journal of consulting and clinical psychology.

[26]  Nicholas Tarrier,et al.  A meta-analysis of the association between posttraumatic stress disorder and suicidality: the role of comorbid depression. , 2012, Comprehensive psychiatry.

[27]  L. Derogatis Brief Symptom Inventory , 2011 .

[28]  Peter Bühlmann,et al.  MissForest - non-parametric missing value imputation for mixed-type data , 2011, Bioinform..

[29]  E. Petkova,et al.  Treatment for PTSD related to childhood abuse: a randomized controlled trial. , 2010, The American journal of psychiatry.

[30]  Trevor Hastie,et al.  Regularization Paths for Generalized Linear Models via Coordinate Descent. , 2010, Journal of statistical software.

[31]  J. Ford,et al.  Exploratory and Confirmatory Factor Analyses of the Structured Interview for Disorders of Extreme Stress , 2008, Assessment.

[32]  Max Kuhn,et al.  Building Predictive Models in R Using the caret Package , 2008 .

[33]  M. Zvolensky,et al.  Linkages between cigarette smoking outcome expectancies and negative emotional vulnerability. , 2008, Addictive behaviors.

[34]  A. Isaksson,et al.  Cross-validation and bootstrapping are unreliable in small sample classification , 2008, Pattern Recognit. Lett..

[35]  R. Sinha,et al.  Difficulties in emotion regulation and impulse control during cocaine abstinence. , 2007, Drug and alcohol dependence.

[36]  Tracie O. Afifi,et al.  Physical and Mental Comorbidity, Disability, and Suicidal Behavior Associated With Posttraumatic Stress Disorder in a Large Community Sample , 2007, Psychosomatic medicine.

[37]  S. Pilling,et al.  Psychological treatments for chronic post-traumatic stress disorder , 2007, British Journal of Psychiatry.

[38]  B. Green,et al.  Disorders of Extreme Stress (DESNOS) Symptoms Are Associated With Type and Severity of Interpersonal Trauma Exposure in a Sample of Healthy Young Women , 2006, Journal of interpersonal violence.

[39]  M. Duffy The Randomized Controlled Trial: Basic Considerations , 2006, Clinical nurse specialist CNS.

[40]  R. Bradley,et al.  A multidimensional meta-analysis of psychotherapy for PTSD. , 2005, The American journal of psychiatry.

[41]  F. Mazzi,et al.  Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project , 2004, Acta psychiatrica Scandinavica. Supplementum.

[42]  K. L. Gratz,et al.  Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale , 2004 .

[43]  E. Foa,et al.  Do Patients Drop Out Prematurely from Exposure Therapy for PTSD? , 2003, Journal of traumatic stress.

[44]  Arnoud Arntz,et al.  Short-interval test-retest interrater reliability of the Dutch version of the Structured Clinical Interview for DSM-IV personality disorders (SCID-II). , 2003, Journal of personality disorders.

[45]  D E Grobbee,et al.  External validation is necessary in prediction research: a clinical example. , 2003, Journal of clinical epidemiology.

[46]  Marylene Cloitre,et al.  Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. , 2002, Journal of consulting and clinical psychology.

[47]  Nathalie Japkowicz,et al.  The class imbalance problem: A systematic study , 2002, Intell. Data Anal..

[48]  R. Kessler,et al.  Posttraumatic stress disorder: the burden to the individual and to society. , 2000, The Journal of clinical psychiatry.

[49]  E. Foa,et al.  The Posttraumatic Cognitions Inventory (PTCI): Development and validation. , 1999 .

[50]  M. Barkham,et al.  The IIP-32: a short version of the Inventory of Interpersonal Problems. , 1996, The British journal of clinical psychology.

[51]  Barbara O. Rothbaum,et al.  Reliability and validity of a brief instrument for assessing post‐traumatic stress disorder , 1993 .

[52]  E. Carlson,et al.  An update on the Dissociative Experiences Scale. , 1993 .

[53]  D. Cox,et al.  An Analysis of Transformations , 1964 .

[54]  Brandon M. Greenwell,et al.  Variable Importance Plots - An Introduction to the vip Package , 2020, R J..

[55]  K. L. Gratz,et al.  Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale , 2008 .

[56]  P. Emmelkamp,et al.  Psychometrische kenmerken van de Nederlandse Posttraumatische Cognities Inventarisatielijst (PTCI) , 2007 .

[57]  Nitesh V. Chawla,et al.  SMOTE: Synthetic Minority Over-sampling Technique , 2002, J. Artif. Intell. Res..

[58]  M. First,et al.  Structured clinical interview for DSM-IV axis II personality disorders : SCID-II , 1997 .

[59]  Carlo Schuengel,et al.  The measurement of dissociation in normal and clinical populations. Meta-analytic validation of the dissociative experiences scale (des) , 1996 .

[60]  P. Myllynen,et al.  A RANDOMISED CLINICAL TRIAL , 1989 .

[61]  G. Brier VERIFICATION OF FORECASTS EXPRESSED IN TERMS OF PROBABILITY , 1950 .