Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-28T07:29:36.674Z Has data issue: false hasContentIssue false
  • English
  • Français

Service Use, Drop-Out Rate and Clinical Outcomes: A Comparison Between High and Low Intensity Treatments in an IAPT Service

Published online by Cambridge University Press:  02 January 2014

Stella W. Y. Chan  and
Malcolm Adams
Stella W. Y. Chan*
Affiliation:
University of East Anglia, Norwich and University of Edinburgh, UK
Malcolm Adams
Affiliation:
University of East Anglia, Norwich, UK
*
Reprint requests to Stella W. Y. Chan, Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AG, UK. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The IAPT services provide high and low intensity psychological treatments for adults suffering from depression and anxiety disorders using a stepped care model. The latest national evaluation study reported an average recovery rate of 42%. However, this figure varied widely between services, with better outcomes associated with higher “step-up” rates between low and high intensity treatments. Aims: This study aimed to compare the two intensity groups in an IAPT service in Suffolk. Method: This study adopted a between groups design. A sample of 100 service users was randomly selected from the data collected from an IAPT service in Suffolk between May 2008 and February 2011. The treatment outcomes, drop-out rate, and other characteristics were compared between those who received high and low intensity treatments. Results: The high intensity group received, on average, more sessions and contact time. They received more CBT sessions and less guided self-help. There were no group differences in terms of the drop-out and appointment cancellation rates. Analyses on clinical outcomes suggested no group difference but demonstrated an overall recovery rate of 52.6% and significant reduction in both depression and anxiety symptoms. Conclusions: Despite methodological limitations, this study concludes that the service as a whole achieved above-average clinical outcomes. Further research building upon the current study in unpacking the relative strengths and weaknesses for the high and low intensity treatments would be beneficial for service delivery.

Keywords

IAPTtreatment outcomedrop-outdepressionanxietyCBT
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 42 , Issue 6 , November 2014 , pp. 747 - 759
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV (4th ed.). Washington, DC: Author.Google Scholar
Bower, P. and Gilbody, S. (2005). Stepped care in psychological therapies: access, effectiveness and efficiency. Narrative literature review. British Journal of Psychiatry, 186, 11–17.CrossRefGoogle ScholarPubMed
Clark, D. M. and Ehlers, A. (1993). An overview of the cognitive theory and treatment of panic disorder. Applied and Preventative Psychology, 2, 131–139.Google Scholar
Clark, D. M., Layard, R., Smithies, R., Richards, D. A., Suckling, R. and Wright, B. (2009). Improving access to psychological therapy: initial evaluation of the two demonstration sites. Behaviour Research and Therapy, 47, 910–920.Google Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). New York: Academic Press.Google Scholar
Gyani, A., Shafran, R., Layard, R. and Clark, D. M. (2011). Enhancing recovering rates in IAPT services: lessons from analysis of the year one data. Retrieved from http://www.iapt.nhs.uk.Google Scholar
Howell, D. C. (2002). Statistical Methods for Psychology (5th ed.). Pacific Grove, CA: Duxbury.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.Google Scholar
Kuyken, W., Byford, S., Taylor, R. S., Watkins, E., Holden, E., White, K., et al. (2008). Mindfulness based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology, 76, 966–978.Google Scholar
Layard, R., Bell, S., Clark, D. M., Knapp, M., Meacher, M., Priebe, S., et al. (2006). The Depression Report: a new deal for depression and anxiety disorders. London: Centre for Economic Performance, London School of Economics.Google Scholar
National Institute for Health and Clinical Excellence (2004a). Depression: management of depression in primary and secondary care (CG23). Retrieved from http://guidance.nice.org.uk/CG23.Google Scholar
National Institute for Health and Clinical Excellence (2004b). Generalised Anxiety Disorder and Panic Disorder (with or without Agoraphobia) in Adults (CG113). Retrieved from http://guidance.nice.org.uk/CG113.Google Scholar
North East Public Health Observatory (NEPHO) (2010). Improving Access to Psychological Therapies: a review of the progress by the sites in the first roll-out year. Stockton on Tees: NEPHO.Google Scholar
Scogin, F., Hanson, A. and Welsh, D. (2003). Self-administered treatment in stepped-care models of depression treatment. Journal of Clinical Psychology, 59, 341–349.Google Scholar
Seekles, W., van Straten, A., Beekman, A., van Marwijk, H. and Cuijpers, P. (2011). Stepped care treatment for depression and anxiety in primary care: a randomised controlled trial. Trials, 12, 171.Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. W. and Lowe, B. (2006). A brief measure for assessing generalised anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.Google Scholar
Shapiro, D. A., Barkham, M., Rees, A., Hardy, G. E., Reynolds, S. and Startup, M. (1994). Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioural and psychodynamic-interpersonal psychotherapies. Journal of Consulting and Clinical Psychology, 62, 522–534.Google Scholar
van Straten, A., Tiemens, B., Hakkaart, L., Nolen, W. A. and Donker, M. C. H. (2006). Stepped care vs. matched care for mood and anxiety disorders: a randomized trial in routine practice. Acta Psychiatrica Scandinavica, 113, 468–476.Google Scholar
Submit a response

Comments

No Comments have been published for this article.