Department of Psychiatry, University of Cambridge, Cambridge, UK.
National Institute for Health Research Applied Research Collaboration (ARC) East of England (EoE), Cambridge, UK.
Psychol Med. 2022 Oct;52(14):3231-3240. doi: 10.1017/S0033291720005395. Epub 2021 Mar 8.
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.
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.
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).
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.
尽管心理疗法的总体效果已得到证实，但患者的治疗效果仍存在显著差异。本研究旨在确定在初级精神卫生保健环境中，与抑郁和焦虑症状基线严重程度、治疗过程中症状变化速度以及症状缓解相关的因素。
本研究使用了英格兰心理和福利服务（改善心理治疗机会，IAPT）中 35527 名患者的数据，采用潜在增长模型来探讨哪些常规收集的社会人口学、临床和治疗变量与基线症状严重程度和症状变化速度相关。我们采用多水平逻辑回归模型来确定与症状缓解相关的变量。
女性、年龄较小、功能障碍更严重、社会经济地位更低与抑郁和焦虑症状的基线严重程度更高相关。年龄较大、功能障碍较轻、基线症状更严重与抑郁和焦虑症状的改善速度更快相关（仅男性和更大的社会经济劣势与抑郁的变化速度进一步相关）。治疗强度和预约频率似乎与症状改善速度无关。基线症状严重程度较低、功能障碍较轻、年龄较大的患者更有可能实现症状缓解（IAPT 标准定义）。
我们必须继续研究如何最好地根据患者的需求调整心理治疗干预措施。那些开始治疗时抑郁和/或焦虑症状更严重且功能障碍更严重的患者需要特别关注，因为这些特征可能会对康复产生负面影响。
