Impact of referral source and study applicants' preference for randomly assigned service on research enrollment, service engagement, and evaluative outcomes

UMMS Affiliation

Department of Psychiatry

Publication Date


Document Type



Adult; Community Mental Health Services; Employment, Supported; Female; Health Services Research; Humans; Male; Mental Disorders; Motivation; Outcome Assessment (Health Care); *Patient Participation; Patient Satisfaction; Proportional Hazards Models; Randomized Controlled Trials as Topic; *Referral and Consultation; Research Design; Research Subjects; Researcher-Subject Relations; Salaries and Fringe Benefits; Survival Analysis


Health Services Research | Mental and Social Health | Psychiatric and Mental Health | Psychiatry | Psychiatry and Psychology


OBJECTIVE: The inability to blind research participants to their experimental conditions is the Achilles' heel of mental health services research. When one experimental condition receives more disappointed participants, or more satisfied participants, research findings can be biased in spite of random assignment. The authors explored the potential for research participants' preference for one experimental program over another to compromise the generalizability and validity of randomized controlled service evaluations as well as cross-study comparisons.

METHOD: Three Cox regression analyses measured the impact of applicants' service assignment preference on research project enrollment, engagement in assigned services, and a service-related outcome, competitive employment.

RESULTS: A stated service preference, referral by an agency with a low level of continuity in outpatient care, and willingness to switch from current services were significant positive predictors of research enrollment. Match to service assignment preference was a significant positive predictor of service engagement, and mismatch to assignment preference was a significant negative predictor of both service engagement and employment outcome.

CONCLUSIONS: Referral source type and service assignment preference should be routinely measured and statistically controlled for in all studies of mental health service effectiveness to provide a sound empirical base for evidence-based practice.

DOI of Published Version



Am J Psychiatry. 2005 Apr;162(4):781-7. Link to article on publisher's site

Journal/Book/Conference Title

The American journal of psychiatry

Related Resources

Link to Article in PubMed

PubMed ID