J. Med. Internet Res. - Posttreatment attrition and its predictors, attrition bias, and treatment efficacy of the anxiety online programs.


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CKGROUND: Although relatively new, the field of e-mental health is becoming more popular with more attention given to researching its various aspects. However, there are many areas that still need further research, especially identifying attrition predictors at various phases of assessment and treatment delivery.OBJECTIVE: The present study identified the predictors of posttreatment assessment completers based on 24 pre- and posttreatment demographic and personal variables and 1 treatment variable, their impact on attrition bias, and the efficacy of the 5 fully automated self-help anxiety treatment programs for generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with or without agoraphobia (PD/A), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).METHODS: A complex algorithm was used to diagnose participants' mental disorders based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders were offered an online 12-week disorder-specific treatment program. A total of 3199 individuals did not formally drop out of the 12-week treatment cycle, whereas 142 individuals formally dropped out. However, only 347 participants who completed their treatment cycle also completed the posttreatment assessment measures. Based on these measures, predictors of attrition were identified and attrition bias was examined. The efficacy of the 5 treatment programs was assessed based on anxiety-specific severity scores and 5 additional treatment outcome measures.RESULTS: On average, completers of posttreatment assessment measures were more likely to be seeking self-help online programs; have heard about the program from traditional media or from family and friends; were receiving mental health assistance; were more likely to learn best by reading, hearing and doing; had a lower pretreatment Kessler-6 total score; and were older in age. Predicted probabilities resulting from these attrition variables displayed no significant attrition bias using Heckman's method and thus allowing for the use of completer analysis. Six treatment outcome measures (Kessler-6 total score, number of diagnosed disorders, self-confidence in managing mental health issues, quality of life, and the corresponding pre- and posttreatment severity for each program-specific anxiety disorder and for major depressive episode) were used to assess the efficacy of the 5 anxiety treatment programs. Repeated measures MANOVA revealed a significant multivariate time effect for all treatment outcome measures for each treatment program. Follow-up repeated measures ANOVAs revealed significant improvements on all 6 treatment outcome measures for GAD and PTSD, 5 treatment outcome measures were significant for SAD and PD/A, and 4 treatment outcome measures were significant for OCD.CONCLUSIONS: Results identified predictors of posttreatment assessment completers and provided further support for the efficacy of self-help online treatment programs for the 5 anxiety disorders.TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).

Resumo Limpo

ckground although relat new field ement health becom popular attent given research various aspect howev mani area still need research especi identifi attrit predictor various phase assess treatment deliveryobject present studi identifi predictor posttreat assess complet base pre posttreat demograph person variabl treatment variabl impact attrit bias efficaci fulli autom selfhelp anxieti treatment program general anxieti disord gad social anxieti disord sad panic disord without agoraphobia pda obsessivecompuls disord ocd posttraumat stress disord ptsdmethod complex algorithm use diagnos particip mental disord base criteria diagnost statist manual mental disord fourth edit text revis dsmivtr receiv primari secondari diagnosi anxieti disord offer onlin week disorderspecif treatment program total individu formal drop week treatment cycl wherea individu formal drop howev particip complet treatment cycl also complet posttreat assess measur base measur predictor attrit identifi attrit bias examin efficaci treatment program assess base anxietyspecif sever score addit treatment outcom measuresresult averag complet posttreat assess measur like seek selfhelp onlin program heard program tradit media famili friend receiv mental health assist like learn best read hear lower pretreat kessler total score older age predict probabl result attrit variabl display signific attrit bias use heckman method thus allow use complet analysi six treatment outcom measur kessler total score number diagnos disord selfconfid manag mental health issu qualiti life correspond pre posttreat sever programspecif anxieti disord major depress episod use assess efficaci anxieti treatment program repeat measur manova reveal signific multivari time effect treatment outcom measur treatment program followup repeat measur anova reveal signific improv treatment outcom measur gad ptsd treatment outcom measur signific sad pda treatment outcom measur signific ocdconclus result identifi predictor posttreat assess complet provid support efficaci selfhelp onlin treatment program anxieti disorderstri registr australian new zealand clinic trial registri actrn httpwwwanzctrorgautrialviewaspxid archiv webcit httpwwwwebcitationorgrwvog

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