TY - JOUR
T1 - Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems
AU - Skelton, Megan
AU - Carr, Ewan
AU - Buckman, Joshua E. J.
AU - Davies, Molly R
AU - Goldsmith, Kimberley
AU - Hirsch, Colette R
AU - Peel, Alicia J
AU - Rayner, Christopher
AU - Rimes, Katharine
AU - Saunders, Rob
AU - Wingrove, Janet
AU - Breen, Gerome
AU - Grant, Thalia Eley
N1 - Funding Information:
MS was funded by an NIHR Maudsley Biomedical Research Centre studentship. JEJB was funded on a fellowship from the Wellcome Trust (201292/Z/16/Z). CR was supported by a grant from Fondation Peters to TCE and GB. AJP was supported by an ESRC studentship. GB has sat on advisory boards for Otsuka and Compass Pathways. The authors declare no conflict of interest.
Funding Information:
This study represents independent research funded by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at SLaM NHS Foundation Trust and King's College London, and the Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or King's College London. The authors acknowledge the valuable work of the NIHR Maudsley Biomedical Research Centre Clinical Record Interactive Search team, especially Matthew Broadbent, who performed the data extraction.
Publisher Copyright:
Copyright © The Author(s), 2022. Published by Cambridge University Press.
PY - 2023/9/25
Y1 - 2023/9/25
N2 - Background There is substantial variation in patient symptoms following psychological therapy for depression and anxiety. However, reliance on endpoint outcomes ignores additional interindividual variation during therapy. Knowing a patient's likely symptom trajectories could guide clinical decisions. We aimed to identify latent classes of patients with similar symptom trajectories over the course of psychological therapy and explore associations between baseline variables and trajectory class. Methods Patients received high-intensity psychological treatment for common mental health problems at National Health Service Improving Access to Psychological Therapies services in South London (N = 16 258). To identify trajectories, we performed growth mixture modelling of depression and anxiety symptoms over 11 sessions. We then ran multinomial regressions to identify baseline variables associated with trajectory class membership. Results Trajectories of depression and anxiety symptoms were highly similar and best modelled by four classes. Three classes started with moderate-severe symptoms and showed (1) no change, (2) gradual improvement, and (3) fast improvement. A final class (4) showed initially mild symptoms and minimal improvement. Within the moderate-severe baseline symptom classes, patients in the two showing improvement as opposed to no change tended not to be prescribed psychotropic medication or report a disability and were in employment. Patients showing fast improvement additionally reported lower baseline functional impairment on average. Conclusions Multiple trajectory classes of depression and anxiety symptoms were associated with baseline characteristics. Identifying the most likely trajectory for a patient at the start of treatment could inform decisions about the suitability and continuation of therapy, ultimately improving patient outcomes.
AB - Background There is substantial variation in patient symptoms following psychological therapy for depression and anxiety. However, reliance on endpoint outcomes ignores additional interindividual variation during therapy. Knowing a patient's likely symptom trajectories could guide clinical decisions. We aimed to identify latent classes of patients with similar symptom trajectories over the course of psychological therapy and explore associations between baseline variables and trajectory class. Methods Patients received high-intensity psychological treatment for common mental health problems at National Health Service Improving Access to Psychological Therapies services in South London (N = 16 258). To identify trajectories, we performed growth mixture modelling of depression and anxiety symptoms over 11 sessions. We then ran multinomial regressions to identify baseline variables associated with trajectory class membership. Results Trajectories of depression and anxiety symptoms were highly similar and best modelled by four classes. Three classes started with moderate-severe symptoms and showed (1) no change, (2) gradual improvement, and (3) fast improvement. A final class (4) showed initially mild symptoms and minimal improvement. Within the moderate-severe baseline symptom classes, patients in the two showing improvement as opposed to no change tended not to be prescribed psychotropic medication or report a disability and were in employment. Patients showing fast improvement additionally reported lower baseline functional impairment on average. Conclusions Multiple trajectory classes of depression and anxiety symptoms were associated with baseline characteristics. Identifying the most likely trajectory for a patient at the start of treatment could inform decisions about the suitability and continuation of therapy, ultimately improving patient outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85172266839&partnerID=8YFLogxK
U2 - 10.1017/S0033291722003403
DO - 10.1017/S0033291722003403
M3 - Article
SN - 0033-2917
VL - 53
SP - 6183
EP - 6193
JO - Psychological Medicine
JF - Psychological Medicine
IS - 13
ER -