Treatment refusal greater for drug therapy than psychotherapyBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1187 (Published 07 March 2017) Cite this as: BMJ 2017;356:j1187
Patients with mental health problems are more likely to refuse treatment or not complete the recommended course if it consists of drug therapy alone than if it comprises psychotherapy alone, a meta-analysis published in the journal Psychotherapy has found.
The rates of treatment refusal were about two times higher for pharmacotherapy alone than for psychotherapy alone, particularly for the treatment of social anxiety disorder, depressive disorders, and panic disorder.1
The researchers examined 186 studies that looked at whether patients with mental health problems accepted the treatment that was recommended and if they did whether they completed it. Fifty seven of the studies, comprising 6693 patients, reported rates of refusal of treatment recommendations, and 182 of the studies, comprising 17 891 patients, reported rates of premature termination of treatment.
An average treatment refusal rate of 8.2% was found across all studies. Patients assigned to pharmacotherapy were 1.76 times more likely to refuse treatment than those who were offered psychotherapy alone.
Patients with social anxiety disorder were 1.97 times more likely to refuse their treatment if they were assigned to pharmacotherapy alone compared with psychotherapy alone. Patients with depression were 2.16 times more likely, and patients with panic disorder were 2.79 times more likely to refuse drug treatment than talking therapies. However the researchers found no differences in refusal rates between the two treatments for anorexia and bulimia, generalised anxiety disorder, mixed anxiety disorders, obsessive compulsive disorder, and post-traumatic stress disorder.
On average 21.9% of patients terminated their treatment early. Across all studies those who were assigned to pharmacotherapy were 1.20 times more likely to drop out than those assigned to psychotherapy. The rates of premature termination of pharmacotherapy were highest for anorexia and bulimia and depressive disorders. No significant differences were found in refusal or dropout rates between pharmacotherapy alone and combination treatments or between psychotherapy alone and combination treatments.
The researchers said that, in addition to treatment efficacy, refusal and dropout rates should be considered when making treatment recommendations.