CLINIC DROPOUT AND ITS CORRELATES AMONG PATIENTS ATTENDING CHILD AND ADOLESCENT MENTAL HEALTH CLINIC AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN

Abstract

Background: Dropout is a common clinical phenomenon among outpatients. It has been defined as a total disengagement from treatment without either clinical resolution of symptoms or agreed treatment plan (Mitchell, 2007). Noncompliance with follow-up could be quite challenging among persons with mental health problems and specifically in children and adolescents, who often depend on their parents/caregivers for care. Since mental disorders are often chronic in nature, continuity of care becomes crucial for an effective delivery of mental health service. With the current treatment coverage that is below expected, missed appointments further drains on available resources and compromises quality of care (Omigbodun, 2001). Aim: The study is aimed at finding the dropout rate and clinical characteristics of patients who drop out in the first year from follow up from a child and adolescent mental health clinic. Methodology: This study was carried out at the child and adolescent mental health clinic of the University College Hospital, Ibadan, Nigeria. It is a cross-sectional study of mixed method type, comprising of a quantitative phase followed by a qualitative phase. Ethical clearance for the study was obtained from the Ethical Review Committee of the University of Ibadan/University College Hospital and verbal voluntary consent was taken from participants of the in-depth interview. A total of 113 new patients who presented between January 2017 and December 2018 and who met the inclusion criteria were recruited for the quantitative part by purposive sampling. Out of those who dropped out of treatment, 25 participants were selected by simple random sampling for an in-depth interview. Socio-demographic questionnaire and discussion guide for the in-depth interview were the instruments used. The quantitative data were analyzed using the statistical package for social sciences version 23 while the qualitative data were coded into themes manually using content analysis. Results: The participants were mostly (58.4%) males and adolescents between 10 and 19 years. The rate of dropout among the participants was 95.6%. The rate of dropout was found to increase with time. The socio-demographic characteristics of participants had no significant association with dropout. Patient’s diagnosis (p=0.107) or presence of comorbidity (p=0.290 was also not associated with dropout. However, the type of treatment received was significantly associated with dropout (p = 0.040). The commonest reason for dropout was no improvement in clinical condition. Other reasons for dropout were feeling of being well, financial constraint, the far distance between residence and hospital and belief that the cause of the illness was spiritual. Conclusion: This study supported previous findings in the literature that dropout is a common phenomenon in outpatient psychiatric care. The rate of dropout among the participants was very high which requires prompt intervention. The majority of those who were contacted on phone were appreciative and showed a willingness to re-initiate treatment, hence could motivate treatment continuation. There is need for a wider health insurance coverage, which incorporates mental health treatment, in order to cater to the financial challenges of accessing care. Furthermore, integrating mental health into primary health care would provide accessible and affordable mental health services for all. Larger studies are required to assess for possible predictors of dropout among children and adolescents which could not be gotten from this study