Determinants of patient-reported outcome trajectories and symptomatic recovery in Improving Access to Psychological Therapies (IAPT) services

Stochl, Jan, Soneson, Emma, Stuart, Freya, Fritz, Jessica, Walsh, Annabel E. L., Croudace, Tim J., Hodgekins, Joanne, Patel, Ushma, Russo, Debra A., Knight, Clare, Jones, Peter B. and Perez, Jesus (2022) Determinants of patient-reported outcome trajectories and symptomatic recovery in Improving Access to Psychological Therapies (IAPT) services. Psychological Medicine, 52 (14). pp. 3231-3240. ISSN 0033-2917

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Background: Despite evidence for the general effectiveness of psychological therapies, there exists substantial heterogeneity in patient outcomes. We aimed to identify factors associated with baseline severity of depression and anxiety symptoms, rate of symptomatic change over the course of therapy, and symptomatic recovery in a primary mental health care setting. Methods: Using data from a service evaluation involving 35 527 patients in England's psychological and wellbeing [Improving Access to Psychological Therapies (IAPT)] services, we applied latent growth models to explore which routinely-collected sociodemographic, clinical, and therapeutic variables were associated with baseline symptom severity and rate of symptomatic change. We used a multilevel logit model to determine variables associated with symptomatic recovery. Results: Being female, younger, more functionally impaired, and more socioeconomically disadvantaged was associated with higher baseline severity of both depression and anxiety symptoms. Being older, less functionally impaired, and having more severe baseline symptomatology was associated with more rapid improvement of both depression and anxiety symptoms (male gender and greater socioeconomic disadvantage were further associated with rate of change for depression only). Therapy intensity and appointment frequency seemed to have no correlation with rate of symptomatic improvement. Patients with lower baseline symptom severity, less functional impairment, and older age had a greater likelihood of achieving symptomatic recovery (as defined by IAPT criteria). Conclusions: We must continue to investigate how best to tailor psychotherapeutic interventions to fit patients’ needs. Patients who begin therapy with more severe depression and/or anxiety symptoms and poorer functioning merit special attention, as these characteristics may negatively impact recovery.

Item Type: Article
Additional Information: Financial support: This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0616-20003). JS, JP, and PBJ received support from the NIHR Applied Research Collaboration (ARC) East of England (EoE) at the Cambridgeshire and Peterborough NHS Foundation Trust. ES is supported by a Gates Cambridge Scholarship. JF is funded by the Medical Research Council Doctoral Training/Sackler Fund and the Pinsent Darwin Fund. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, the MRC or the Gates Cambridge Trust.
Uncontrolled Keywords: improving access to psychological therapies,patient-reported outcomes,predictors,psychotherapy,symptomatic recovery,applied psychology,psychiatry and mental health,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/3200/3202
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Mental Health
Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health
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Depositing User: LivePure Connector
Date Deposited: 27 Feb 2021 01:03
Last Modified: 19 Oct 2023 02:55
DOI: 10.1017/S0033291720005395

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