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    New Insights on Treatment Refusal of Pharmacotherapy and Psychotherapy

    A meta-analysis casts light on therapy compliance issues among patients with different mental health disorders.


    High rates of refusal for mental health treatment may be due to patient skepticism regarding pharmacotherapy according to new research published in the journal Psychotherapy.

    The study is a meta-analysis from 186 trials involving thousands of patients that reported on treatment refusal or premature termination of treatment. Overall, the researchers found that the average treatment refusal rate was 8.2%.

    They found that patients assigned to pharmacotherapy treatment alone were 1.76 times more likely to refuse treatment than those who were assigned psychotherapy alone. The differences were even starker in patients suffering from depressive, panic, and social anxiety disorders. Those suffering from depressive disorders were 2.16 times more likely to refuse treatment when prescribed pharmacotherapy alone, and patients with panic disorders were almost three times as likely to refuse treatment.

    Related article: Directory connects pharmacies and mental health patients

    Additionally, early treatment termination rates were 21.9% overall, with patients prescribed only pharmacotherapy treatments 1.2 times more likely to end treatment early. There were no significant differences in refusal or dropout rates found between prescribing either pharmacotherapy or psychotherapy alone versus a combination treatment.

    According to co-author Roger Greenberg, PhD, Professor of Psychology at the State University of New York's Upstate Medical University in Syracuse, these findings are especially interesting because, as a result of easier access, recent trends show that a greater percentage of mental health patients are engaging in pharmacotherapy than psychotherapy in the United States.

    The research supports the argument that psychotherapy should be the first treatment option for many mental disorders, Greenberg said, in a statement about the study from the American Psychological Association. “Our findings support that argument, showing that clients are more likely to be willing to start and continue psychotherapy than pharmacotherapy,” he said. 

    Up next: How pharmacists can help increase treatment acceptance


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