School of Psychology, Trinity College Dublin, Dublin, Ireland.
Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
Int J Behav Med. 2024 Oct;31(5):730-740. doi: 10.1007/s12529-023-10215-9. Epub 2023 Sep 11.
Low-intensity psychological interventions may be a cost-effective, accessible solution for treating depression and anxiety in patients with long-term conditions, but evidence from real-world service settings is lacking. This study examined the effectiveness of low-intensity psychological interventions provided in the Improving Access to Psychological Therapies programme in England for patients with and without long-term conditions.
A retrospective analysis was conducted on patients (total N = 21,051, long-term conditions n = 4024) enrolled in three low-intensity psychological interventions, i.e. Internet-delivered cognitive behavioural therapy (iCBT), guided self-help (GSH), and psychoeducational group therapy (PGT) within a Talking Therapies service from 2016 to 2020. Primary outcomes included pre-post-treatment changes in depression (Patient Health Questionnaire-9) and anxiety (Generalised Anxiety Disorder-7).
Overall, both cohorts significantly improved on all outcomes post-treatment, with large effect sizes. Patients with long-term conditions experienced a greater reduction in depression while those without experienced a greater reduction in anxiety, but these differences were marginal (< 1 score difference on both measures). No difference between the cohorts was shown when comparing the differential effectiveness across interventions, but those engaging in iCBT showed greater reduction in depression and anxiety than those in GSH and PGT, while those in GSH improved more than PGT.
Low-intensity psychological interventions, particularly iCBT, were effective in treating depression and anxiety in patients with long-term conditions in a real-world service setting. Our large-scale study supports the continued and increased implementation of low-intensity psychological interventions for this subpopulation via integrated care.
低强度心理干预可能是一种具有成本效益且易于获得的解决方案，可用于治疗患有长期疾病的患者的抑郁和焦虑，但现实服务环境中缺乏相关证据。本研究考察了在英国改善心理治疗服务计划中为患有和不患有长期疾病的患者提供的低强度心理干预的有效性。
对 2016 年至 2020 年期间在 Talking Therapies 服务中接受三种低强度心理干预（即互联网认知行为疗法(iCBT)、指导性自助(GSH)和心理教育小组治疗(PGT)）的患者（共 21051 名，患有长期疾病的患者 n=4024）进行了回顾性分析。主要结局包括治疗前后抑郁（患者健康问卷-9）和焦虑（广泛性焦虑障碍-7）的变化。
总体而言，两个队列在治疗后所有结局上均显著改善，且具有较大的效应量。患有长期疾病的患者在抑郁方面的改善程度更大，而没有长期疾病的患者在焦虑方面的改善程度更大，但这些差异较小（两个测量指标的差异均小于 1 分）。在比较干预措施的差异有效性时，两个队列之间没有差异，但与 GSH 和 PGT 相比，接受 iCBT 的患者在抑郁和焦虑方面的改善程度更大，而接受 GSH 的患者的改善程度则大于 PGT。
低强度心理干预，特别是 iCBT，在现实服务环境中对患有长期疾病的患者的抑郁和焦虑治疗有效。我们的大规模研究支持通过综合护理为这一亚人群继续和增加低强度心理干预的实施。
