Publication Date

2017-05-29

Availability

Open access

Embargo Period

2017-05-29

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Psychology (Arts and Sciences)

Date of Defense

2016-08-30

First Committee Member

Amy Weisman de Mamani

Second Committee Member

Gail H. Ironson

Third Committee Member

Saneya H. Tawfik

Fourth Committee Member

Franklin H. Foote

Fifth Committee Member

Edward Rappaport

Abstract

Attrition (or premature treatment dropout), particularly from family treatments, continues to be a poorly understood phenomenon. High attrition rates mean that patients with schizophrenia and their caregivers are not obtaining the benefits that family treatments offer (e.g., reductions in symptom severity and caregiver burden) and are also experiencing additional negative outcomes (e.g., poorer patient social functioning, poorer caregiver mental health). Although research consistently demonstrates that certain demographic factors, such as being an ethnic minority, predict greater attrition from treatment, we know little about sociocultural factors that may explain why these relationships exist. In a sample of 115 families that were enrolled in a larger project comparing family treatments for schizophrenia (a culturally informed treatment for schizophrenia (CIT-S) versus a psycho-education comparison condition (PSY-ED), we hypothesized that families in which patients and caregivers had higher levels of interdependence, lower levels of independence, higher levels of family cohesion, and engaged in more adaptive religious coping and less maladaptive religious coping, would be more likely to remain in treatment/attend a greater number of family therapy sessions. Data was analyzed in the full sample (CIT-S and PSY-ED families combined) as well as separated by treatment condition. Results from several statistical analytic approaches are presented (binary logistic regression, multiple linear regression, survival analysis, content analysis). In line with study hypotheses, results across treatment conditions and analyses consistently demonstrated that greater maladaptive religious coping, particularly in caregivers, was associated with an increased likelihood of attrition/fewer family therapy sessions attended. However, contrary to expectations, greater adaptive religious coping was also found to be associated with an increased likelihood of family attrition/fewer family therapy sessions attended. Additionally, in the subsample of PSY-ED families, results indicated that families in which patients had lower levels of independence were less likely to drop out of treatment prematurely when compared to families with patients who had higher independence scores. No other significant predictor variables were identified. Results suggest more religious individuals may already be getting the support and guidance they need from their spiritual/religious institutions which may aid them in coping with their own/their relative’s mental illness. Results may also suggest a “religiosity gap” in which religious individuals may perceive a disconnect between their beliefs and the beliefs of their providers. Therefore, modifications to how family treatments are marketed and presented to families may be warranted so that individuals feel treatments are congruent with their religious beliefs. Further, as survival analyses indicated that families tend to drop out of treatment early on, we may also want to ensure that the most critical information is delivered in the first few sessions. Additional implications for the current study are discussed.

Keywords

schizophrenia; religiosity; religious coping; attrition; premature dropout; family therapy

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