Premature termination of treatment for anorexia nervosa: Differences between patient-initiated and staff-initiated discharge

• Published in: The International journal of eating disorders 2014-01, Vol.47 (1), p.40-46
• Main Authors: Sly, Richard, Mountford, Victoria A., Morgan, John F., Lacey, J. Hubert
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anorexia; anorexia nervosa; Anorexia Nervosa - psychology; Anorexia Nervosa - therapy; behavior change; Body Mass Index; Clinical outcomes; Coercion; Cohort Studies; Discharge; dropout; Eating disorders; Female; Hospitalization; Humans; Length of Stay; Male; Medical personnel; Medical treatment; Middle Aged; Motivation; Patient Discharge - statistics & numerical data; Patient Dropouts - psychology; Patient Dropouts - statistics & numerical data; Patients; Professional-Patient Relations; Psychotherapeutic Processes; Refusal to Treat - statistics & numerical data; Surveys and Questionnaires; Survival Analysis; therapeutic alliance; Treatment Outcome; United Kingdom; Young Adult
• ISSN: 0276-3478; 1098-108X
• DOI: 10.1002/eat.22190

ABSTRACT Objectives To investigate treatment drop‐out by comparing clinical indicators of patients whose discharge was initiated by staff with those who initiated discharge themselves. Method Ninety participants with anorexia completed questionnaires at admission and four weeks into hospitalized treatment. Weight data was collected over this same period. At discharge, participants were categorized into completer (n = 38) or patient‐initiated (n = 36) /staff‐initiated (n = 16) premature termination groups. Results Significant differences between staff‐initiated and patient‐initiated discharge groups were found at admission. Staff initiated groups were on average older (p = .035), and more likely to have had prior compelled treatment (p = .039). At 4 weeks those in the patient‐initiated group had put on weight at a faster rate (p = .032) and reported a decrease in alliance (p = .017). At discharge, staff initiated discharge demonstrated greater time in treatment (p = .001), greater weight gain (p = .027), and a higher discharge BMI (p = .013). At discharge, staff‐initiated drop‐outs had comparable end‐of‐treatment outcomes to those who completed treatment as planned. Discussion There are key differences between those who prematurely discharge themselves from treatment, compared to those who are prematurely discharged by clinical staff. Future research into drop‐out needs to take into account and recognize these differences. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:40–46)