Claudia Savard

Development and Validation of the Treatment Attrition-Retention Scale for Personality Disorders

This study is an investigation of the psychometric properties of the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD), an instrument developed to identify patients with personality disorder (PD) at risk of early dropout from psychotherapy. In a first study, assessment files from 320 patients referred for PD evaluation at an outpatient clinic were examined to assess the instruments inter-rater reliability, construct validity, and discriminant validity. Results showed that the global scale could be scored with excellent reliability. Exploratory factor analysis identified five factors: Narcissism, Psychopathy, Secondary gains, Low motivation, and Cluster A features. A second study focused on the scales predictive validity. The TARS-PD showed high specificity (94%) in identifying dropouts, using a cut-off of ≥ 10. Both global and factor scores from the TARS-PD were significant predictors of treatment status (dropout vs. continuation) at 6 months. The scale should be considered promising for PD evaluation and treatment planning.

Trimester-Specific Dietary Intakes in a Sample of French-Canadian Pregnant Women in Comparison with National Nutritional Guidelines

Diet during pregnancy greatly impacts health outcomes. This study aims to measure changes in dietary intakes throughout trimesters and to assess pregnant women’s dietary intakes in comparison with current Canadian nutritional recommendations. Seventy-nine pregnant women were recruited and completed, within each trimester, three Web-based 24-h dietary recalls and one Web questionnaire on supplement use. Dietary intakes from food, with and without supplements, were compared to nutritional recommendations throughout pregnancy. Energy and macronutrient intakes remained stable throughout pregnancy. A majority of women exceeded their energy and protein requirements in the first trimester, and fat intakes as a percentage of energy intakes were above recommendations for more than half of the women in all trimesters. Supplement use increased dietary intakes of most vitamins and minerals, but 20% of women still had inadequate total vitamin D intakes and most women had excessive folic acid intakes. This study showed that pregnant women did not increase their energy intakes throughout pregnancy as recommended. Furthermore, although prenatal supplementation reduces the risk of inadequate intake for most micronutrients, there is still a risk of excessive folic acid and insufficient vitamin D intake, which needs further investigation.

Premature psychotherapy termination in an outpatient treatment program for personality disorders: a survival analysis

OBJECTIVE Psychological treatment for patients with personality disorders (PD) is plagued with a high proportion of early dropouts, and attempts to identify risk factors for attrition have generated very few conclusive results. The purpose of the present study is to identify significant predictors of early treatment termination in a long-term psychotherapy program for PD. METHODS Data was retrospectively retrieved from 174 files of patients who began long-term psychotherapy in an outpatient treatment program in Quebec City, Canada. Socio-demographic, initial disturbance, and diagnostic variables were considered for prediction, along with a measure specifically designed to identify PD patients at risk of dropping out early from psychotherapy, the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD). Survival analysis using Cox proportional hazard regression was performed to identify significant predictors. RESULTS Results using univariate Cox proportional hazards regressions revealed that unemployment, Global Assessment of Functioning scores, and recent hetero-aggressive behavior were significant predictors of early dropout in the first six months of therapy. Adjusting for these three confounders, four of the factor scores from the TARS-PD (Narcissism, Secondary gains, Low distress, and Cluster A features) were significantly associated with dropout in univariate Cox proportional hazards regressions. Secondary gains and Narcissism remained significant predictors after entering all five TARS-PD factors in a multivariate Cox proportional hazards regression adjusting for confounders. CONCLUSIONS Taking into consideration specific treatment prognosis variables, such as those measured by the TARS-PD, might be more useful for dropout prediction in PD patients in comparison with more general demographic and diagnostic variables.