Gender Differences Between Domestic Violent Men and Women: Criminogenic Risk Factors and Their Association With Treatment Dropout

Although many studies have concluded that men and women engage in domestic violence at equal levels, existing studies have hardly focused on gender specific risk factors for domestic violence perpetration. Therefore, this study aimed to examine gender differences in criminogenic risk factors between Dutch male and female forensic outpatients who were referred to forensic treatment for domestic violence. Clinical structured assessments of criminogenic risk factors were retrieved for 366 male and 87 female outpatients. Gender differences were not only found in the prevalence and interrelatedness of criminogenic risk factors, but also in associations between criminogenic risk factors and treatment dropout. In men, risk factors related to the criminal history, substance abuse, and criminal attitudes were more prevalent than in women, whereas risk factors related to education/work, finances, and the living environment were more prevalent in women. Further, having criminal friends, having a criminal history, and drug abuse were associated with treatment dropout in men, whereas a problematic relationship with family members, housing instability, a lack of personal support, and unemployment were associated with treatment dropout in women. Finally, network analyses revealed gender differences in risk factor interrelatedness. The results provide important insights into gender specific differences in criminogenic risk factors for domestic violence, which support clinical professionals in tailoring treatment to the specific needs of male and female perpetrators of domestic violence.

Does Confinement Affect Treatment Dropout Rates in Patients With Gambling Disorder? A Nine-Month Observational Study

Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout.Methods: The sample consisted of n=86 adults, mostly men (n=79, 91.9%) and with a mean age of 45years old (SD=16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown).Results: The risk of dropout during the complete observational period was R=32/86=0.372 (37.2%), the Incidence Density Rate (IDR) ratio T2/T1 being equal to 0.052/0.033=1.60 (p=0.252). Shorter treatment duration (p=0.007), lower anxiety (p=0.025), depressive symptoms (p=0.045) and lower use of adaptive coping strategies (p=0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment (p=0.001) and higher employment concerns (p=0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods (p=0.005 and p<0.001, respectively).Conclusion: The present results suggest an impact of the COVID-19 pandemic on treatment dropout among patients with GD during and after the lockdown, being treatment duration a predictor of dropout. Assessing vulnerability features in GD may help clinicians identify high-risk individuals and enhance prevention and treatment approaches in future similar situations.

Exposure Quality in Cognitive Behavioral Treatment for Youth Anxiety Disorders—Predictors and Associations with Outcomes

To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work. Exposure to feared situations is an effective CBT component. However, there is little observation-based empirical research on how exposure relates to outcomes and other clinical variables. In a randomized controlled community clinic trial for youth with anxiety disorders, observers reliably rated exposure quality for 68 youths aged 8 to 15 years based on 118 videotaped sessions. The treatment program was the manual-based FRIENDS program. Three exposure quality elements (preparation, post-processing, and parent contribution to exposure) were examined in relation to pre-treatment demographic and clinical variables, outcomes, and youth- and therapist-rated alliance using multilevel hierarchical regression models. The outcomes were diagnostic recovery, clinical severity and anxiety symptoms change from pre- to post-treatment and one-year follow-up, and treatment dropout. The results showed that parent contribution to exposure was higher for boys and younger children. Parent contribution to exposure, but no other exposure element, was associated with a larger likelihood of diagnostic recovery and larger clinical severity reduction at one-year follow-up. Exposure quality was unrelated to outcomes at post-treatment, dropout, or alliance. We conclude that enhancing parent contribution to exposure during treatment could improve long-term outcomes after CBT for youth anxiety disorders. Exposure elements should be observed in larger samples to further examine their potential role for CBT outcomes.

Predictors of Discontinuation From Individual Treatment in Men Perpetrators of Intimate Partner Violence

Practitioners working with male perpetrators of intimate partner violence (IPV) observe high rates of treatment dropout in their clientele, which can undermine their ability to reduce the occurrence of IPV. Studies have also mostly documented predictors of dropout from group-format IPV treatment programs, but not from individual-format treatment modalities. This study aimed to identify the predictors and key moments of dropout in 206 French-Canadian men seeking individual treatment for IPV. Results of Cox regression survival analyses indicate that age, education, employment, court-ordered treatment, adult attachment, and the number of perpetrated acts of psychological violence were significant predictors of dropout. Findings highlight the need to assess and target those predictors early in treatment to help men remain in therapy and prevent further use of IPV.

The effect of early therapeutic alliance on treatment dropout in cognitive processing therapy and client factors as moderators of this relationship

Although efficacious treatments, including Cognitive Processing Therapy (CPT), are available for treating Posttraumatic Stress Disorder (PTSD), a substantial number of clients do not receive a full course of CPT due to clients dropping out prematurely. Examining factors associated with treatment dropout may increase our understanding on how to tailor interventions to prevent treatment dropout. This study examined the relationship between early therapeutic alliance and treatment dropout, and client age and pretreatment PTSD symptom severity as predictors of dropout and moderators of the alliance-dropout association. Clients were part of a larger randomized implementation trial, and either began CPT and dropped out (n = 38) or completed 12 sessions of CPT (n = 74). Results indicated early therapeutic alliance did not significantly predict treatment dropout, and age and PTSD severity were not significant predictors or moderators of the alliance-dropout association. Clinical implications of the findings are discussed.

The effect of early therapeutic alliance on treatment dropout in cognitive processing therapy and client factors as moderators of this relationship

Although efficacious treatments, including Cognitive Processing Therapy (CPT), are available for treating Posttraumatic Stress Disorder (PTSD), a substantial number of clients do not receive a full course of CPT due to clients dropping out prematurely. Examining factors associated with treatment dropout may increase our understanding on how to tailor interventions to prevent treatment dropout. This study examined the relationship between early therapeutic alliance and treatment dropout, and client age and pretreatment PTSD symptom severity as predictors of dropout and moderators of the alliance-dropout association. Clients were part of a larger randomized implementation trial, and either began CPT and dropped out (n = 38) or completed 12 sessions of CPT (n = 74). Results indicated early therapeutic alliance did not significantly predict treatment dropout, and age and PTSD severity were not significant predictors or moderators of the alliance-dropout association. Clinical implications of the findings are discussed.

Determinants of Time to Treatment Dropout among Tuberculosis Patients in Buno-Bedele and Illu Ababora Zones, Oromia Regional State, Ethiopia

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. It typically affects the lungs (pulmonary tube) but, can affect other parts of the body as well (extra pulmonary tube). The study was aimed to investigate the determinants of time to drop out of treatment for TB patients. Secondary data was used from 375 TB patients of the selected health stations and hospitals at Buno-Bedele and Illu Aba Bora Zones. The response variable for this study was the survival time (Time to dropout the treatment among TB patients) measured in days and the covariates were gender of the patient, marital status, HIV co-infection, Phase of TB treatment, TB type, TB category, Previous TB history, HIV Co infection, Anemia and Physical inactivity. Descriptive statistics, Kaplan-Meier Estimation method, Semi-parametric survival models and parametric survival models were used for the analysis of time to TB treatment dropout dataset. From 375 patients who started TB treatments about 24.8% dropout and 75.2% censored at the end of the study and the median survival time of TB patients were 199 days. The Log-rank results showed that marital status, HIV co infection, Diabetic mellitus, Cancer and Anemia cases had significant difference between the survival experience at 5% level of significance, whose different levels have an impact in the survival time of TB patients; whereas Sex, Phase of TB treatment, TB type, TB category, previous TB status, co-morbidity, and physical inactive had not significant difference between the survival experience at 5% level of significance. Finally, the result of Cox-proportion hazard model showed that, age, HIV co-infection and Anemia had a significant effect on tuberculosis patients during the study period.