Department of Psychiatry
Penn Behavioral Health

Center for Psychotherapy Research

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Community Partnership Studies

Attrition and Engagement Studies

Investigators at the Center for Psychotherapy Research are engaged in several attrition studies designed to understand why patients in community settings who suffer from depression often do not continue their treatment regimens.

Depression is one of the most common disorders in Community Mental Health Centers. A recent census of Northwestern Human Services of Philadelphia (NHSP) showed that more than 50 percent of consumers are diagnosed with some type of depression. Furthermore, empirically supported treatments for depression suggest the most effective therapy requires 8-16 sessions.

Despite decades of investigating factors contributing to attrition, obstacles to the delivery and success of treatments remain poorly understood and effective methods to engage and retain patients in treatment are lacking. Although early treatment withdrawal has repeatedly been linked to placement on a waiting list, economic disadvantage, minority status, or limited education, interventions addressing such factors have not increased retention. Remarkably, consumers disengage from mental health services at a rate comparable to that found over 50 years ago. Moreover, research has focused almost exclusively on dropout during treatment, although more than 60 percent of consumers initiating contact with a mental health clinic withdraw prior to treatment onset. Since most consumers disengage from services during the initial contacts with the agency, it becomes essential to understand why someone requesting service does not follow through. Ultimately, understanding and improving retention rates for consumers with depression could prove most beneficial to effectively implementing these treatments in the community mental health setting.

Engagement and Attrition in Community Health Settings - Two pilot studies are being conducted to focus on attrition during the engagement phase (i.e., no show after intake) and on attrition from treatment itself.

The specific aims of this study are to:

  • Examine qualitatively and quantitatively the nature of initial engagement in treatment and subsequent retention/attrition with an eye towards potential modifications in empirically-supported psychotherapies for major depressive disorder that could be made to increase their relevance and success to a community mental health population.
  • Systematically assess attrition after intake as well as during treatment itself,
  • Examine the impact of various manifestations of attrition on identified correlates and contributors, and
  • Incorporate consumer perceptions into all assessments and intervention development.

Early Engagement in Community Mental Health Treatment - This attrition study seeks to identify and empirically confirm factors that predict dropout within depressed adult consumers of community mental health services.

The specific aims of this study are to:

  • Assess the perceptions of consumers about attrition at various points in the process of engagement, and
  • Identify explicit consumer, staff, setting, and community factors predictive of attrition.


Principal Investigator:  
Marna S. Barrett, PhD (NIMH funding)

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To learn more about our current treatment programs, research protocols, or to ask specific questions about the Center, please call us at 215-349-5222.