OBJECTIVE: This review aims to estimate the overall and differential rates of attrition in CA-delivered mental health interventions (CA interventions), evaluate the impact of study design and intervention-related aspects on attrition, and describe study design features aimed at reducing or mitigating study attrition.
METHODS: We searched PubMed, Embase (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and Web of Science, and conducted a gray literature search on Google Scholar in June 2022. We included randomized controlled trials that compared CA interventions against control groups and excluded studies that lasted for 1 session only and used Wizard of Oz interventions. We also assessed the risk of bias in the included studies using the Cochrane Risk of Bias Tool 2.0. Random-effects proportional meta-analysis was applied to calculate the pooled dropout rates in the intervention groups. Random-effects meta-analysis was used to compare the attrition rate in the intervention groups with that in the control groups. We used a narrative review to summarize the findings.
RESULTS: The systematic search retrieved 4566 records from peer-reviewed databases and citation searches, of which 41 (0.90%) randomized controlled trials met the inclusion criteria. The meta-analytic overall attrition rate in the intervention group was 21.84% (95% CI 16.74%-27.36%; I2=94%). Short-term studies that lasted ≤8 weeks showed a lower attrition rate (18.05%, 95% CI 9.91%- 27.76%; I2=94.6%) than long-term studies that lasted >8 weeks (26.59%, 95% CI 20.09%-33.63%; I2=93.89%). Intervention group participants were more likely to attrit than control group participants for short-term (log odds ratio 1.22, 95% CI 0.99-1.50; I2=21.89%) and long-term studies (log odds ratio 1.33, 95% CI 1.08-1.65; I2=49.43%). Intervention-related characteristics associated with higher attrition include stand-alone CA interventions without human support, not having a symptom tracker feature, no visual representation of the CA, and comparing CA interventions with waitlist controls. No participant-level factor reliably predicted attrition.
CONCLUSIONS: Our results indicated that approximately one-fifth of the participants will drop out from CA interventions in short-term studies. High heterogeneities made it difficult to generalize the findings. Our results suggested that future CA interventions should adopt a blended design with human support, use symptom tracking, compare CA intervention groups against active controls rather than waitlist controls, and include a visual representation of the CA to reduce the attrition rate.
BACKGROUND: PROSPERO International Prospective Register of Systematic Reviews CRD42022341415; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341415.
目的:这篇综述旨在估计CA提供的心理健康干预(CA干预)的总体和差异流失率,评估研究设计和干预相关方面对减员的影响,并描述旨在减少或减轻研究流失的研究设计特征。
方法:我们搜索了PubMed,Embase(Ovid),PsycINFO(Ovid),Cochrane中央控制试验登记册,和WebofScience,并于2022年6月对GoogleScholar进行了灰色文献检索。我们纳入了随机对照试验,将CA干预措施与对照组进行比较,并排除了仅持续1个疗程并使用绿野仙踪干预措施的研究。我们还使用Cochrane偏差风险工具2.0评估了纳入研究的偏差风险。随机效应比例荟萃分析用于计算干预组的合并辍学率。采用随机效应荟萃分析比较干预组与对照组的流失率。我们使用叙述性综述来总结研究结果。
结果:系统搜索从同行评审数据库和引文搜索中检索了4566条记录,其中41项(0.90%)随机对照试验符合纳入标准.干预组的meta分析总体流失率为21.84%(95%CI16.74%-27.36%;I2=94%)。持续≤8周的短期研究显示,流失率较低(18.05%,95%CI9.91%-27.76%;I2=94.6%)比持续>8周的长期研究(26.59%,95%CI20.09%-33.63%;I2=93.89%)。在短期研究(对数比值比1.22,95%CI0.99-1.50;I2=21.89%)和长期研究(对数比值比1.33,95%CI1.08-1.65;I2=49.43%)中,干预组参与者比对照组参与者更容易被减员。与较高减员相关的干预相关特征包括没有人力支持的独立CA干预,没有症状追踪功能,没有CA的视觉表示,并将CA干预措施与等待名单对照进行比较。没有参与者水平的因素可靠地预测了自然减员。
结论:我们的结果表明,在短期研究中,大约五分之一的参与者将退出CA干预。高度异质性使得很难推广这些发现。我们的结果表明,未来的CA干预措施应采用人工支持的混合设计,使用症状跟踪,将CA干预组与主动对照而不是等待列表对照进行比较,并包括CA的视觉表示以降低流失率。
背景:PROSPERO国际系统评价前瞻性注册CRD42022341415;https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42022341415。