Impact of long-term medical conditions on the outcomes of psychological therapy for depression and anxiety

Background: Long-term conditions often coexist with depression and anxiety.

Aims: To assess the effectiveness of stepped-care psychological therapies for patients with long-term conditions.

Method: Data from 28 498 patients were analysed using regression to model depression (Patient Health Questionnaire (PHQ-9)) and anxiety (Generalised Anxiety Disorder scale (GAD-7)) outcomes. Post-treatment symptoms and effect sizes (d) were estimated for individuals with and without long-term conditions, controlling for covariates. The likelihood of access and response to intensive psychological interventions was also examined.

Results: Higher post-treatment symptoms were predicted for patients with musculoskeletal problems (d = 0.22–0.27), chronic obstructive pulmonary disease (d = 0.26–0.33), diabetes (d = 0.05–0.13) and psychotic disorders (d = 0.50–0.58). Most long-term conditions were associated with greater odds of accessing high-intensity therapies, yet individuals who accessed these continued to have higher average post-treatment symptoms.

Conclusions: Some long-term conditions are associated with greater intensity of care and poorer outcomes after therapy.