JMIR Publications

ABSTRACT

Background:

Blended therapy (BT) combines digital applications with face-to-face treatment and has become an increasingly important component of psychiatric care. Evidence indicates that BT can achieve outcomes comparable to, or even superior to those of traditional face-to-face therapy. Despite certain advantages, routine implementation of BT remains challenging, and clinical practice suggests that while some inpatients engage with BT, many either discontinue early or do not initiate its use at all. To better understand these patterns, this multicentric retrospective observational study investigates factors associated with non-initiation and dropout among inpatients offered BT.

Objective:

In this study, data from 278 inpatients were analysed to examine the influence of sociodemographic variables, comorbidities, and symptom severity on the uptake and continued use of BT. The objective was to identify predictors of non-initiation and dropout.

Methods:

Multivariable logistic regression models were conducted to identify significant predictors of non-initiation and dropout.

Results:

The findings indicate distinct patterns of association for non-initiation and dropout. Specifically, increasing age was linked to a lower risk of non-initiation (OR (per year age difference) = 0.98, 95% CI [0.96, 1.00], p = 0.013), while the presence of a comorbid anxiety disorder was associated with a reduced risk of dropout (OR = 0.23, 95% CI [0.08, 0.66], p = 0.007). Several variables showed no association with either non-initiation or dropout across all analyses, including sex, overall symptom severity, and certain comorbidities such as personality disorders and depression.

Conclusions:

The age-related finding aligns with existing literature suggesting that older adults show higher willingness to continue with internet-based treatment. Explanations for this could be having more realistic expectations regarding treatment, greater persistence, or the likelihood that only intrinsically motivated older adults choose to even engage in digital therapies. Regarding comorbid anxiety disorders, previous literature provides no consistent conclusions about its role in dropout. However, the lower dropout rates observed in this subgroup may reflect specific personality traits or indicate that these patients benefit more from the highly structured nature of BT. It is possible that the modules offered on the platform are particularly well-suited to addressing core mechanisms of anxiety disorders, thereby enhancing perceived relevance and user engagement. In conclusion, the findings highlight the importance of identifying patient characteristics that predict successful engagement with BT. Tailoring the use of BT to those more likely to adhere may support more effective and resource-conscious implementation in clinical inpatient settings.