Wheeler Mark H, Orbell Sheina, Rakow Tim
Department of Psychology, University of Essex, Colchester, United Kingdom.
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Clin Psychol Eur. 2023 Dec 22;5(4):e10237. doi: 10.32872/cpe.10237. eCollection 2023 Dec.
Well-defined measures of therapeutic benefit are essential for evaluating therapies and services. However, there is no single gold standard for defining 'successful' outcomes. We therefore examined the potential impact of adopting different success criteria.
We analysed data for 7,064 patients undergoing psychological therapy in a single UK IAPT (Increasing Access to Psychological Therapy) Service, each patient being assessed for depression (PHQ-9) and anxiety (GAD-7) both at the start and end of treatment. Predictors of successful outcomes based on these measures were analysed separately for three different success criteria: based either on assessing clinically significant change, or reliable change, in depression and anxiety.
The choice of criteria had little bearing on which variables predicted successful outcomes. However, the direction of the relationship between initial PHQ-9 or GAD-7 score and outcome success reverses when the criteria used to judge success are changed: successful outcomes are less probable under clinically significant change criteria for patients entering the service with more severe depression and/or anxiety but are more probable for such patients under reliable change criteria.
Relevant for clinicians, researchers, and policymakers, the choice of success criteria adopted can substantially change the incentives for patient selection into a therapy service. Our analysis highlights how the methods used to evaluate treatment outcomes could impact the priorities and organisation of therapeutic services, which could then impact on who is offered treatment. We recommend further investigations of success criteria in other conditions or treatments to determine the reproducibility of the effects we found.
明确的治疗效果衡量标准对于评估治疗方法和服务至关重要。然而，对于定义“成功”结果并没有单一的金标准。因此，我们研究了采用不同成功标准的潜在影响。
我们分析了英国一家单一的改善心理治疗可及性（IAPT）服务机构中7064名接受心理治疗患者的数据，每位患者在治疗开始和结束时均接受抑郁（PHQ-9）和焦虑（GAD-7）评估。基于这些测量指标，针对三种不同的成功标准分别分析成功结果的预测因素：这三种标准分别基于评估抑郁和焦虑方面具有临床意义的变化或可靠变化。
标准的选择对预测成功结果的变量影响不大。然而，当用于判断成功的标准改变时，初始PHQ-9或GAD-7评分与结果成功之间关系的方向会发生逆转：对于进入该服务时抑郁和/或焦虑程度更严重的患者，在具有临床意义的变化标准下成功结果的可能性较小，但在可靠变化标准下此类患者成功结果的可能性更大。
对于临床医生、研究人员和政策制定者而言，所采用的成功标准的选择可能会大幅改变患者选择治疗服务的动机。我们的分析突出了用于评估治疗结果的方法如何可能影响治疗服务的重点和组织，进而可能影响接受治疗的人群。我们建议在其他病症或治疗中进一步研究成功标准，以确定我们所发现效果的可重复性。
