Abstract
Individuals with schizophrenia spectrum disorders appear to be at high risk for dropout from treatment. Despite these findings, few studies have examined the potential impact that sociocultural variables may play in treatment dropout within this vulnerable population. Moreover, very little work has examined the function of these variables in group therapy (an approach that has increased in popularity and may be less susceptible to attrition) and even less work has examined how these variables function among racial/ethnic minorities, who appear to be at higher risk for treatment dropout than Whites. The current study aimed to expand upon the literature by examining whether sociocultural factors (specifically familial involvement, stigma, religion/spirituality, and explanatory models of mental illness) relate to attrition in a sample of racially/ethnically diverse patients and family members enrolled in a group intervention for schizophrenia. On an exploratory basis, we also examined whether independent/collectivistic self construals, perceptions of familial warmth and criticism, and general psychological well-being related to attrition, and examined the specific session(s) in which participants were most likely to drop out of the CIGT-S program. Participants included 101 patients with schizophrenia and 25 family members of patients with schizophrenia. Data was examined using the full sample of patients and family members, and using patient data only. In line with our hypotheses, results indicated that participants with a family member involved in the treatment program attended more group sessions, thereby demonstrating lower rates of attrition. However, contrary to our hypotheses, stigma, religion/spirituality, explanatory models of mental illness, and our exploratory variables did not significantly predict attrition. Survival analyses revealed that most participants dropped out of the CIGT-S program before treatment began, but those participants who made it to session 9 (thus completing all cultural components of the intervention) were unlikely to drop out. Results from a series of Kaplan-Meir analyses also indicated that nonminorities, patients who had low levels of symptom severity, and participants who had a family member involved in the treatment program attended a higher number of treatment sessions, thereby demonstrating lower levels of attrition from the CIGT-S program. Results suggest that familial involvement in treatment may be a strong protective factor against attrition for participants in psychotherapy for schizophrenia. As such, the integration of strategies to increase familial involvement in treatment planning and delivery may serve to reduce treatment dropout within this population. Additionally, survival analyses indicated that rates of attrition dropped substantially after completion of CIGT-S’ culturally specific treatment modules. Thus, inclusion of these modules earlier on in treatment, and integration of cultural content into each session may serve to enhance treatment engagement at the onset of treatment, thereby reducing dropout. Additional implications of the current work and directions for future study are also presented and discussed.