Dropping out of mental health treatment among patients with depression and anxiety by type of provider: results of the European Study of the Epidemiology of Mental Disorders

  • Alejandra Pinto-Meza
  • Anna Fernández
  • Ronny Bruffaerts
  • Jordi Alonso
  • Viviane Kovess
  • Ron De Graaf
  • Giovanni de Girolamo
  • Herbert Matschinger
  • Josep M. Haro
Original Paper



Dropping out from mental health treatment is a major problem because mental health treatments delivered for inadequate durations are ineffective. The aim of this study was to compare treatment dropout rates by type of provider, dropout risk by number of visit, and to ascertain factors associated with treatment dropout.


A cross-sectional household survey of a representative sample of 626 out of 21,425 non-institutionalized adults from the general population of six European countries was carried out. Dropout was defined as terminating treatment before recommendation.


Dropout from all treating providers during a 12-month period was 14%. Among psychiatrists, psychologists, and general practitioners figures were: 19.6, 20.3, and 20.3%, respectively. While the hazard risk for dropping out was higher during the first three visits to GPs and psychologists, it was stable for psychiatrists. Older age, female gender, and living in large or midsize urban areas were associated with a decreased risk of dropping out.


Efforts for increasing patients’ proportion completing adequate courses of care for mental disorders in Europe should focus on the first visits, especially those made to the general medical care.


Dropout Epidemiology Mental disorders Psychiatrists General practitioners 



The survey discussed in this article was carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the WMH staff for assistance with instrumentation, fieldwork, and data analysis. A complete list of WMH publications can be found at

Conflict of interest statement

The authors declare that they have no conflict of interest.


  1. 1.
    Melfi CA, Chawla AJ, Croghan TW, Hanna MP, Kennedy S, Sredl K (1998) The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression. Arch Gen Psychiatry 55:1128–1132PubMedCrossRefGoogle Scholar
  2. 2.
    Wells KB, Sherbourne C, Schoenbaum M, Duan N, Meredith L, Unützer J, Miranda J, Carney MF, Rubenstein LV (2000) Impact of disseminating quality improvement programs for depression in managed primary care: a randomised controlled trial. JAMA 283:212–220PubMedCrossRefGoogle Scholar
  3. 3.
    Edlund MJ, Wang PS, Berglund PA, Katz SJ, Lin E, Kessler RC (2002) Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. Am J Psychiatry 159:845–851PubMedCrossRefGoogle Scholar
  4. 4.
    Wang J (2007) Mental health treatment dropout and its correlates in a general population sample. Med Care 45:224–229PubMedCrossRefGoogle Scholar
  5. 5.
    Olfson M, Mojtabai R, Sampson N, Hwang I, Druss B, Wang PS, Wells KB, Pincus HA, Kessler RC (2009) Dropout from outpatient menatla health care in the United States. Psychiatr Serv 60:898–907PubMedCrossRefGoogle Scholar
  6. 6.
    Melo AP, Guimaraes MD (2005) Factors associated with psychiatric treatment dropout in a mental health reference center, Belo Horizonte. Rev Bras Psiquiatr 27:113–118PubMedCrossRefGoogle Scholar
  7. 7.
    Morlino M, Martucci G, Musella V, Bolzan M, de Girolamo G (1995) Paients dropping out of treatment in Italy. Acta Psychiatr Scand 92:1–6PubMedCrossRefGoogle Scholar
  8. 8.
    Wang PS, Gilman SE, Guardino M, Christiana JM, Morselli PL, Nickelson K, Kessler RC (2000) Initiation of and adherence to treatment for mental disorders: examination of patient advocate group members in 11 countries. Med Care 38:926–936PubMedCrossRefGoogle Scholar
  9. 9.
    Alonso J, Angermeyer MC, Bernert S et al (2004) European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 420(Suppl):47–54Google Scholar
  10. 10.
    Alonso J, Angermeyer MC, Bernert S et al (2004) European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 420(Suppl):8–20Google Scholar
  11. 11.
    Kessler RC, Ustun TB (2004) The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Res 13:93–121CrossRefGoogle Scholar
  12. 12.
    American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Author, Washington, DCGoogle Scholar
  13. 13.
    Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lepine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC (2006) Concordance of the Composite International Diagnostic Interview (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. Int J Methods Psychiatr Res 15:167–180PubMedCrossRefGoogle Scholar
  14. 14.
    Sheehan DV, Harnett-Sheehan K, Raj BA (1996) The measurement of disability. Int Clin Psychopharmacol 11(Suppl 3):89–95PubMedCrossRefGoogle Scholar
  15. 15.
    STATA Statistical Software [computer program] (2005) Release 9. StataCorp LP, College Station, TexasGoogle Scholar
  16. 16.
    Alonso J, Angermeyer MC, Bernert S et al (2004) European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. Use of mental health services in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. Acta Psychiat Scand 420(Suppl):47–54Google Scholar
  17. 17.
    Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC (2005) Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:629–640PubMedCrossRefGoogle Scholar
  18. 18.
    O’Brien A, Fahmy R, Singh SP (2009) Disengagement from mental health services. Soc Psychiatry Psychiatr Epidemiol 44:558–568PubMedCrossRefGoogle Scholar
  19. 19.
    Johansson H, Eklund M (2006) Helping alliance and early dropout from psychiatric out-patient care. Soc Psychiatry Psychiatr Epidemiol 41:140–147PubMedCrossRefGoogle Scholar
  20. 20.
    Rossi A, Amaddeo F, Bisoffi G, Ruggeri M, Thornicroft G, Tansella M (2002) Dropping out of care: inappropriate terminations of contact with community-based psychiatric services. Br J Psychiatry 181:331–338PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Alejandra Pinto-Meza
    • 1
  • Anna Fernández
    • 1
  • Ronny Bruffaerts
    • 2
  • Jordi Alonso
    • 3
  • Viviane Kovess
    • 4
  • Ron De Graaf
    • 5
  • Giovanni de Girolamo
    • 6
  • Herbert Matschinger
    • 7
  • Josep M. Haro
    • 1
  1. 1.Parc Sanitari Sant Joan de DeuBarcelonaSpain
  2. 2.Department of Neurosciences and PsychiatryUniversity Hospital GasthuisbergLeuvenBelgium
  3. 3.Health Services Research Unit, Institut Municipal d’ Investigació Mèdica (IMIM-Hospital del Mar)BarcelonaSpain
  4. 4.Department of EpidemiologyEA 4069 Paris Descartes University, EHESP (School of Public Health)ParisFrance
  5. 5.Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
  6. 6.IRCCS Centro S. Giovanni di Dio-FatebenefratelliBresciaItaly
  7. 7.Psychiatry DepartmentUniversity of LeipzigLeipzigGermany

Personalised recommendations