Predictors of Pretreatment Dropout in a Sample of Syrian Refugee Children and Adolescents with Mental Health Difficulties in Lebanon: A Mixed Methods Study

Abstract

Dropout from child and adolescent mental health interventions accounts for up to half of all patients who access them, is higher than adult dropout rate, and has serious implications for service delivery (Wergeland, Fjermestad, Marin, Haugland, Silverman, Öst, Havik & Heiervang, 2015). Research on predictors of pretreatment dropout has identified risk factors based on several variables. However, past research is limited by different operationalizations of dropout, poor differentiation among the different levels of dropout, and a lack of qualitative studies of reasons for dropout. In addition, no known study has explored pretreatment dropout in low resource humanitarian settings, where the context of delivery is often more complex and challenging.

This mixed-method study aimed to explore predictors of pretreatment dropout in a sample of Syrian refugee children and adolescents with mental health difficulties in Lebanon. Using secondary data (N = 152), we tested the effect of symptom profile, age, gender, socio-economic-status, distance to clinic, and time gap on attending the intake session.

Results indicated that only higher levels of PTSD were associated with higher likelihood of attendance. Families (N = 9) were also interviewed to explore qualitatively the reasons for dropout. Content analysis revealed 4 themes and 12 subthemes. Themes were around practical and logistical challenges, stigma and shame, perceptions of mental health services, and perceptions of mental health difficulties.

These findings inform future strategies to improve access to mental health care for this population, such as compensating for transportation costs and adopting community-based interventions.