Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5018, Bergen, Norway.
Department of Clinical Psychology, University of Bergen, Bergen, Norway.
BMC Psychiatry. 2018 Aug 16;18(1):260. doi: 10.1186/s12888-018-1838-0.
Prompt mental health care (PMHC) is a Norwegian initiative, inspired by the English 'Improving Access to Psychological Therapy' (IAPT), aimed to provide low-threshold access to primary care treatment for persons with symptoms of anxiety and depression. The objectives of the present study are to describe the PMHC service, to examine changes in symptoms of anxiety and depression following treatment and to identify predictors of change, using data from the 12 first pilot sites.
A prospective cohort design was used. All participants were asked to complete questionnaires at baseline, before each treatment session and at the end of treatment. Effect sizes (ES) for pre-post changes and recovery rates were calculated based on the Patient Health Questionnaire and the Generalized Anxiety Disorder scale. Multiple imputation (MI) was used in order to handle missing data. We examined predictors through latent difference score models and reported the contribution of each predictor level in terms of ES.
In total, N = 2512 clients received treatment at PMHC between October 2014 and December 2016, whereof 61% consented to participate. The changes from pre- to post-treatment were large for symptoms of both depression (ES = 1.1) and anxiety (ES = 1.0), with an MI-based reliable recovery rate of 58%. The reliable recovery rate comparable to IAPT based on last-observation-carried-forward was 48%. The strongest predictors for less improvement were having immigrant background (ES change depression - 0.27, ES change anxiety - 0.26), being out of work at baseline (ES change depression - 0.18, ES change anxiety - 0.35), taking antidepressants (ES change anxiety - 0.36) and reporting bullying as cause of problems (ES change depression - 0.29). Taking sleep medication did on the other hand predict more improvement (ES change depression 0.23, ES change anxiety 0.45).
Results in terms of clinical outcomes were promising, compared to both the IAPT pilots and other benchmark samples. Though all groups of clients showed substantial improvements, having immigrant background, being out of work, taking antidepressant medication and reporting bullying as cause stood out as predictors of poorer treatment response. Altogether, PMHC was successfully implemented in Norway. Areas for improvement of the service are discussed.
及时心理健康护理（PMHC）是一项挪威发起的计划，灵感来自英国的“改善心理治疗机会”（IAPT），旨在为有焦虑和抑郁症状的人提供初级保健治疗的低门槛机会。本研究的目的是描述 PMHC 服务，检查治疗后焦虑和抑郁症状的变化，并使用来自 12 个试点的第一阶段的数据确定变化的预测因素。
采用前瞻性队列设计。所有参与者在基线、每次治疗前和治疗结束时都被要求完成问卷。使用患者健康问卷和广泛性焦虑障碍量表，基于患者健康问卷和广泛性焦虑障碍量表，计算了治疗前后变化的效应量（ES）和恢复率。使用多重插补（MI）来处理缺失数据。我们通过潜在差异评分模型检查了预测因素，并以 ES 表示每个预测因素水平的贡献。
2014 年 10 月至 2016 年 12 月，共有 2512 名客户在 PMHC 接受治疗，其中 61%同意参与。从治疗前到治疗后的变化对抑郁（ES=1.1）和焦虑（ES=1.0）症状都很大，基于 MI 的可靠恢复率为 58%。与基于最后一次观测结转的 IAPT 相比，可靠恢复率相当，为 48%。改善较少的最强预测因素是具有移民背景（抑郁 ES 变化-0.27，焦虑 ES 变化-0.26）、基线时失业（抑郁 ES 变化-0.18，焦虑 ES 变化-0.35）、服用抗抑郁药（焦虑 ES 变化-0.36）和报告欺凌是问题的原因（抑郁 ES 变化-0.29）。另一方面，服用睡眠药物则预示着更大的改善（抑郁 ES 变化 0.23，焦虑 ES 变化 0.45）。
与 IAPT 试点和其他基准样本相比，在临床结果方面，结果是有希望的。尽管所有组的客户都有了实质性的改善，但具有移民背景、失业、服用抗抑郁药和报告欺凌是问题的原因等预测因素表明，治疗反应较差。总体而言，PMHC 在挪威成功实施。讨论了服务改进的领域。
