Predictors of outcome in psychological therapy for co-morbid long-term health conditions and common mental health problems: an observation cohort study

McDonald, Jason Alan Edwin

Abstract

Co-morbid long-term conditions (LTCs) and common mental health problems are highly prevalent and continue to be associated with poorer health and social outcomes. Recent policy frameworks have endorsed the need to expand mental health provision for patients with LTCs by providing greater access to psychological therapies in Talking Therapies services. However, current evidence suggests patients with longterm health problems accessing psychological therapies experience poorer outcomes than patients without a LTC. The reasons for this are yet to be fully established, but there are suggestions that a number of patient, service level, and treatment factors may be involved.

Accordingly, this study aimed to investigate the influence pre-treatment patient characteristics, the organisation delivery of psychological therapies, and early improvement in treatment have on end of treatment outcomes for people with cooccurring physical and common mental health problems.

Using a 2-year retrospective observational cohort design, anonymised data from 583 patients accessing a Talking Therapies services were analysed using unadjusted binary logistic regression models. Several pre-treatment demographic and clinical patient characteristics, stepped-care factors (type of treatment and number of sessions), and early reliable improvement (ERI) in treatment were used as predictor variables to establish their relationship with reliable recovery.

The results found 54% of patients achieved reliable recovery which is above the national benchmark of 50%. Several predictors were found to influence end of treatment outcomes. Multimorbidity, the number of previous treatment episodes, and the severity of baseline depression, anxiety and functional impairment, were found to negatively influence reliable recovery. Age, employment status, the number of treatment sessions provided, and early reliable improvement (ERI), had a positive association with reliable recovery.

Unlike previous research into this area, the results found patients with LTCs achieved comparable outcomes to patients without LTCs. Most notably, early reliable improvement was found to have the most significant positive association with reliable recovery. This has clinical implications as it suggests a focus on outcome monitoring in the early phase of treatment may have an important role in identifying patients who are likely to achieve recovery, and conversely, those who may not be on track to achieve positive treatment outcomes. Thus, it provides the opportunity to adapt treatment early to increase the chances of improved end of treatment outcomes.

Citation

McDonald, J. A. E. Predictors of outcome in psychological therapy for co-morbid long-term health conditions and common mental health problems: an observation cohort study. (Thesis). Keele University. https://keele-repository.worktribe.com/output/1109374

• Thesis Type: Thesis
• Deposit Date: Mar 20, 2025
• Publicly Available Date: Mar 20, 2025
• Public URL: https://keele-repository.worktribe.com/output/1109374
• Award Date: 2025-03