Predictors of Dropout in Family-Based Psychosocial Treatment for Pediatric Bipolar Disorder: An Exploratory Study

Family-based psychosocial treatments have been developed to address the significant impairments in psychosocial functioning among youth with pediatric bipolar disorder (PBD), yet factors impacting engagement in these treatments have yet to be extensively studied. Early termination from treatment may lead to negative outcomes among youth with PBD. Thus, the primary aim of this exploratory study was to identify predictors and moderators of treatment dropout in PBD. Drawing from the child attrition literature, this study examined characteristics likely to be associated with dropout in families affected by PBD, including potential targets of treatment. Using Cox proportional hazards regressions, we explored the impact of modifiable parent, child, and family characteristics (i.e., parent stress, family coping, child symptoms) and stable demographic characteristics (i.e., family income, ethnic minority status) on dropout among 59 youth aged 7 to 13 who participated in a randomized clinical trial comparing a manualized psychotherapy for PBD (child- and family-focused cognitive behavioral therapy; CFF-CBT) versus treatment as usual (TAU). Specifically, we explored whether dropout was related to baseline levels and changes in these characteristics over the course of treatment in CFF-CBT versus TAU. Findings provide preliminary support for high parental stress as a predictor of dropout across treatments and low baseline parent coping as a predictor of retention in CFF-CBT specifically. Worsening of child depression symptoms over treatment predicted greater likelihood of dropout in CFF-CBT. Finally, improvement in children’s global functioning was associated with reduced dropout across treatments. Results have important implications for tailoring interventions for PBD.