Marit Knapstad1,2, Linn Vathne Lervik3, Solbjørg Makalani Myrtveit Sæther3, Leif Edvard Aarø3, Otto Robert F Smith3. 1. Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway, marit.knapstad@uib.no. 2. Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway, marit.knapstad@uib.no. 3. Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.
Abstract
BACKGROUND: The innovative treatment model Improving Access to Psychological Therapies (IAPT) and its Norwegian adaptation, Prompt Mental Health Care (PMHC), have been evaluated by cohort studies only. Albeit yielding promising results, the extent to which these are attributable to the treatment thus remains unsettled. OBJECTIVE: To investigate the effectiveness of the PMHC treatment compared to treatment as usual (TAU) at 6-month follow-up. METHODS: A randomized controlled trial with parallel assignment was performed in two PMHC sites (Sandnes and Kristiansand) and enrolled clients between November 9, 2015 and August 31, 2017. Participants were 681 adults (aged ≥18 years) considered for admission to PMHC due to anxiety and/or mild to moderate depression (Patient Health Questionnaire [PHQ-9]/Generalized Anxiety Disorder scale [GAD-7] scores above cutoff). These were randomly assigned (70:30 ratio; n = 463 to PMHC, n = 218 to TAU) with simple randomization within each site with no further constraints. The main outcomes were recovery rates and changes in symptoms of depression (PHQ-9) and anxiety (GAD-7) between baseline and follow-up. Primary outcome data were available for 73/67% in PMHC/TAU. Sensitivity analyses based on observed patterns of missingness were also conducted. Secondary outcomes were work participation, functional status, health-related quality of life, and mental well-being. RESULTS: A reliable recovery rate of 58.5% was observed in the PMHC group and of 31.9% in the TAU group, equaling a between-group effect size of 0.61 (95% CI 0.37 to 0.85, p < 0.001). The differences in degree of improvement between PMHC and TAU yielded an effect size of -0.88 (95% CI -1.23 to -0.43, p < 0.001) for PHQ-9 and -0.60 (95% CI -0.90 to -0.30, p < 0.001) for GAD-7 in favor of PMHC. All sensitivity analyses pointed in the same direction, with small variations in point estimates. Findings were slightly more robust for depressive than anxiety symptoms. PMHC was also more effective than TAU in improving all secondary outcomes, except for work participation (z = 0.415, p = 0.69). CONCLUSIONS: The PMHC treatment was substantially more effective than TAU in alleviating the burden of anxiety and depression. This adaptation of IAPT is considered a viable supplement to existing health services to increase access to effective treatment for adults who suffer from anxiety and mild to moderate depression. A potential effect on work participation needs further examination.
RCT Entities:
BACKGROUND: The innovative treatment model Improving Access to Psychological Therapies (IAPT) and its Norwegian adaptation, Prompt Mental Health Care (PMHC), have been evaluated by cohort studies only. Albeit yielding promising results, the extent to which these are attributable to the treatment thus remains unsettled. OBJECTIVE: To investigate the effectiveness of the PMHC treatment compared to treatment as usual (TAU) at 6-month follow-up. METHODS: A randomized controlled trial with parallel assignment was performed in two PMHC sites (Sandnes and Kristiansand) and enrolled clients between November 9, 2015 and August 31, 2017. Participants were 681 adults (aged ≥18 years) considered for admission to PMHC due to anxiety and/or mild to moderate depression (Patient Health Questionnaire [PHQ-9]/Generalized Anxiety Disorder scale [GAD-7] scores above cutoff). These were randomly assigned (70:30 ratio; n = 463 to PMHC, n = 218 to TAU) with simple randomization within each site with no further constraints. The main outcomes were recovery rates and changes in symptoms of depression (PHQ-9) and anxiety (GAD-7) between baseline and follow-up. Primary outcome data were available for 73/67% in PMHC/TAU. Sensitivity analyses based on observed patterns of missingness were also conducted. Secondary outcomes were work participation, functional status, health-related quality of life, and mental well-being. RESULTS: A reliable recovery rate of 58.5% was observed in the PMHC group and of 31.9% in the TAU group, equaling a between-group effect size of 0.61 (95% CI 0.37 to 0.85, p < 0.001). The differences in degree of improvement between PMHC and TAU yielded an effect size of -0.88 (95% CI -1.23 to -0.43, p < 0.001) for PHQ-9 and -0.60 (95% CI -0.90 to -0.30, p < 0.001) for GAD-7 in favor of PMHC. All sensitivity analyses pointed in the same direction, with small variations in point estimates. Findings were slightly more robust for depressive than anxiety symptoms. PMHC was also more effective than TAU in improving all secondary outcomes, except for work participation (z = 0.415, p = 0.69). CONCLUSIONS: The PMHC treatment was substantially more effective than TAU in alleviating the burden of anxiety and depression. This adaptation of IAPT is considered a viable supplement to existing health services to increase access to effective treatment for adults who suffer from anxiety and mild to moderate depression. A potential effect on work participation needs further examination.
Authors: Jan Philipp Klein; Thomas Berger; Johanna Schröder; Christina Späth; Björn Meyer; Franz Caspar; Wolfgang Lutz; Alice Arndt; Wolfgang Greiner; Viola Gräfe; Martin Hautzinger; Kristina Fuhr; Matthias Rose; Sandra Nolte; Bernd Löwe; Gerhard Anderssoni; Eik Vettorazzi; Steffen Moritz; Fritz Hohagen Journal: Psychother Psychosom Date: 2016-05-27 Impact factor: 17.659
Authors: Daniel Zahra; Adam Qureshi; William Henley; Rod Taylor; Cath Quinn; Jill Pooler; Gillian Hardy; Alexandra Newbold; Richard Byng Journal: Int J Psychiatry Clin Pract Date: 2014-03-16 Impact factor: 1.812
Authors: Tine Nordgreen; Thomas Haug; Lars-Göran Öst; Gerhard Andersson; Per Carlbring; Gerd Kvale; Tone Tangen; Einar Heiervang; Odd E Havik Journal: Behav Ther Date: 2015-10-28
Authors: Joep van Agteren; Matthew Iasiello; Laura Lo; Jonathan Bartholomaeus; Zoe Kopsaftis; Marissa Carey; Michael Kyrios Journal: Nat Hum Behav Date: 2021-04-19
Authors: Ángel Aguilera-Martín; Mario Gálvez-Lara; Fátima Cuadrado; Eliana Moreno; Francisco García-Torres; José F Venceslá; Jorge Corpas; Francisco J Jurado-González; Roger Muñoz-Navarro; César González-Blanch; Paloma Ruiz-Rodríguez; Sara Barrio-Martínez; Maider Prieto-Vila; María Carpallo-González; Antonio Cano-Vindel; Juan A Moriana Journal: BMC Psychiatry Date: 2022-02-09 Impact factor: 3.630