Estimating the effectiveness of an enhanced ‘Improving Access to Psychological Therapies’ (IAPT) service addressing the wider determinants of mental health: A real-world evaluation

Alice Porter*, Matthew Franklin, Frank de Vocht , Katrina d'Apice, Esther Louise Curtin, Patricia N Albers, Judi L Kidger

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background. Addressing the wider determinants of mental health alongside psychological therapy could improve mental health service outcomes and population mental health.

Objectives. To estimate the effectiveness of an enhanced ‘Improving Access to Psychological Therapies’ (IAPT) mental health service compared to traditional IAPT in England. Alongside traditional therapy treatment, the enhanced service included wellbeing support and community service links.

Design: A real-world evaluation using IAPT’s electronic health records.

Setting: Three NHS IAPT services in England.

Participants: Data from 17,642 service users classified as having a case of depression and/or anxiety at baseline.

Intervention: We compared the enhanced IAPT service (intervention) to an IAPT service in a different region providing traditional treatment only (geographical-control), and the IAPT service with traditional treatment before additional support was introduced (historical-control).

Primary outcome measures: Patient Health Questionnaire-9 (PHQ-9) depression scale (score range: 0-27) and Generalised Anxiety Disorder-7 (GAD-7) anxiety scale (score range: 0-21); for both, lower scores indicate better mental health. Propensity scores were used to estimate inverse probability of treatment weights, subsequently used in mixed-effects regression models.

Results: Small improvements (mean, 95% CI) were observed for PHQ-9 (depression) (-0.21, -0.32 to -0.09) and GAD-7 (anxiety) (-0.23, -0.34 to -0.13) scores in the intervention-group compared to the historical-control. There was little evidence of statistically significant differences between intervention and geographical-control.

Conclusions: Embedding additional health and wellbeing support into standard IAPT services may lead to improved mental health outcomes. However, the lack of improved outcomes compared to the geographical-control may instead reflect a more general improvement to the intervention IAPT service. It is not clear from our findings whether an IAPT service with additional health and wellbeing support is clinically superior to traditional IAPT models.
Original languageEnglish
Article numbere077220
Pages (from-to)1-11
Number of pages11
JournalBMJ Open
Volume14
Issue number1
DOIs
Publication statusPublished - 30 Jan 2024

Bibliographical note

Funding Information:
This study was supported by the National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR), Grant Reference Number SPHR-PHPES004-IAPT. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2024 BMJ Publishing Group. All rights reserved.

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