Correlates of Attendance in Psychiatric Services: A Critical Review

Abstract

Attendance and dropout are concerning problems in the mental health field. With dropout rates averaging around 50%, mental health agencies lose money and resources invested in missed appointments and under-attended groups, providers lose valuable time, and consumers do not receive recommended levels of services. While there is research on consumer, provider, and agency factors that affect attendance, it has not been integrated and reviewed in the context of community services for those with psychotic disorders. The authors conducted a critical review of literature examining correlates of attendance in community services provided to samples with psychotic disorders as the most prominent diagnostic category. Twenty-two studies were identified that met inclusion criteria. Over 100 unique correlates of attendance were tested; the authors categorized these into eight content areas: demographics, current functioning, history (psychiatric/functional), neurocognitive functioning, services/treatment, social functioning, self-stigma/insight, and symptoms/psychopathology. Correlates were also sorted according to how often they were examined and how many times they were found to be significantly related to consumer attendance. The category containing the most unique correlates was symptoms/psychopathology. Demographic correlates were researched the most, with three unique correlates examined in over ten studies (age, sex, and living situation). Of these demographic correlates, all but two were found significant 25% of the time or less, and none exceeded 40%. Alternatively, some correlates have been investigated few times, but with promising results and theoretical connections to attendance, such as baseline illness severity, which has been found significant in 75% of analyses. There is evidence that researchers are examining correlates for which there is little empirical evidence of a connection to attendance. This may lead to missed opportunities to maximize attendance, use of services, and resources. Implications for future research in the area are discussed.