Psychiatric morbidity and treatment pathway outcomes of patients presenting to specialist NHS psychodynamic psychotherapy services: results from a multi-centre study.

OBJECTIVE

Little is known about socio-demographic, diagnostic, and clinical characteristics of patients referred for assessment to psychodynamic psychotherapy services. The aim of this study was to remedy this by prospectively collecting comprehensive and systematic demographic and clinical information on a large number of patients referred to NHS psychodynamic psychotherapy services.

DESIGN

Fourteen psychotherapy services operating within a National Health Service joined the study and contributed data for 1,136 patients referred from primary and secondary care clinics.

METHOD

Patients were assessed using questionnaires and self-rated measures, which included the clinician-based version of the diagnostic form of the Millon clinical multi-axial inventory-III-revised edition (MCMI-III-R), the brief symptom inventory (BSI), the inventory of interpersonal problems (IIP), and the clinical outcome in routine evaluation (CORE). The pathway from assessment through to treatment and variables associated with treatment uptake and exclusion are described and examined.

RESULTS

Most patients were in the moderate to severe range of psychiatric severity at the time of presentation. Ninety-five percent met clinically based criteria for a psychiatric disorder (mostly anxiety and mood disorders) and/or personality disorder. Although the majority of patients were found suitable for treatment (N=935, 82%), analysis of uptake showed relatively high rates of treatment rejection by patients and treatment drop-out. Partial outcome data at 6-month follow-up after intake into treatment revealed significant change but modest effect size (d=0.35).

CONCLUSION

Systematic collection of baseline and outcome data would provide a national database of the performance of psychotherapy services that would be invaluable in facilitating comparative studies.