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

Jan Stochl; Emma Soneson; Freya Stuart; Jessica Fritz; Annabel E. L. Walsh; Tim Croudace; Joanne Hodgekins; Ushma Patel; Debra A. Russo; Clare  Knight; Peter B. Jones; Jesús Perez

doi:10.1017/S0033291720005395

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

Jan Stochl (Lead / Corresponding author), Emma Soneson, Freya Stuart, Jessica Fritz, Annabel E. L. Walsh, Tim Croudace, Joanne Hodgekins, Ushma Patel, Debra A. Russo, Clare Knight, Peter B. Jones, Jesús Perez

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Abstract

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.

Original language	English
Pages (from-to)	3231-3240
Number of pages	10
Journal	Psychological Medicine
Volume	52
Issue number	14
Early online date	8 Mar 2021
DOIs	https://doi.org/10.1017/S0033291720005395
Publication status	Published - Oct 2022

Keywords

Improving Access to Psychological Therapies
patient-reported outcomes
predictors
psychotherapy
symptomatic recovery

ASJC Scopus subject areas

Applied Psychology
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1017/S0033291720005395Licence: CC BY

Final Published Version
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re- use, distribution and reproduction, provided the original article is properly cited. Stochl, J., Soneson, E., Stuart, F., Fritz, J., Walsh, A., Croudace, T., . . . Perez, J. (2022). Determinants of patient-reported outcome trajectories and symptomatic recovery in Improving Access to Psychological Therapies (IAPT) services. Psychological Medicine, 52(14), 3231-3240. doi:10.1017/S0033291720005395
Final published version, 408 KBLicence: CC BY

Cite this

Stochl, J., Soneson, E., Stuart, F., Fritz, J., Walsh, A. E. L., Croudace, T., Hodgekins, J., Patel, U., Russo, D. A., Knight, C., Jones, P. B., & Perez, J. (2022). Determinants of patient-reported outcome trajectories and symptomatic recovery in Improving Access to Psychological Therapies (IAPT) services. Psychological Medicine, 52(14), 3231-3240. https://doi.org/10.1017/S0033291720005395

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

abstract = "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.",

keywords = "Improving Access to Psychological Therapies, patient-reported outcomes, predictors, psychotherapy, symptomatic recovery",

author = "Jan Stochl and Emma Soneson and Freya Stuart and Jessica Fritz and Walsh, {Annabel E. L.} and Tim Croudace and Joanne Hodgekins and Ushma Patel and Russo, {Debra A.} and Clare Knight and Jones, {Peter B.} and Jes{\'u}s Perez",

note = "Funding Information: 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. Copyright: {\textcopyright} The Author(s), 2021. Published by Cambridge University Press.",

year = "2022",

month = oct,

doi = "10.1017/S0033291720005395",

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volume = "52",

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Stochl, J, Soneson, E, Stuart, F, Fritz, J, Walsh, AEL, Croudace, T, Hodgekins, J, Patel, U, Russo, DA, Knight, C, Jones, PB & Perez, J 2022, 'Determinants of patient-reported outcome trajectories and symptomatic recovery in Improving Access to Psychological Therapies (IAPT) services', Psychological Medicine, vol. 52, no. 14, pp. 3231-3240. https://doi.org/10.1017/S0033291720005395

TY - JOUR

T1 - Determinants of patient-reported outcome trajectories and symptomatic recovery in Improving Access to Psychological Therapies (IAPT) services

AU - Stochl, Jan

AU - Soneson, Emma

AU - Stuart, Freya

AU - Fritz, Jessica

AU - Walsh, Annabel E. L.

AU - Croudace, Tim

AU - Hodgekins, Joanne

AU - Patel, Ushma

AU - Russo, Debra A.

AU - Knight, Clare

AU - Jones, Peter B.

AU - Perez, Jesús

N1 - Funding Information: 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. Copyright: © The Author(s), 2021. Published by Cambridge University Press.

PY - 2022/10

Y1 - 2022/10

N2 - 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.

AB - 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.

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DO - 10.1017/S0033291720005395

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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