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Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems

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 dec...

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Autores principales: Skelton, Megan, Carr, Ewan, Buckman, Joshua E. J., Davies, Molly R., Goldsmith, Kimberley A., Hirsch, Colette R., Peel, Alicia J., Rayner, Christopher, Rimes, Katharine A., Saunders, Rob, Wingrove, Janet, Breen, Gerome, Eley, Thalia C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10520600/
https://www.ncbi.nlm.nih.gov/pubmed/36510471
http://dx.doi.org/10.1017/S0033291722003403
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author Skelton, Megan
Carr, Ewan
Buckman, Joshua E. J.
Davies, Molly R.
Goldsmith, Kimberley A.
Hirsch, Colette R.
Peel, Alicia J.
Rayner, Christopher
Rimes, Katharine A.
Saunders, Rob
Wingrove, Janet
Breen, Gerome
Eley, Thalia C.
author_facet Skelton, Megan
Carr, Ewan
Buckman, Joshua E. J.
Davies, Molly R.
Goldsmith, Kimberley A.
Hirsch, Colette R.
Peel, Alicia J.
Rayner, Christopher
Rimes, Katharine A.
Saunders, Rob
Wingrove, Janet
Breen, Gerome
Eley, Thalia C.
author_sort Skelton, Megan
collection PubMed
description 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.
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spelling pubmed-105206002023-09-27 Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems Skelton, Megan Carr, Ewan Buckman, Joshua E. J. Davies, Molly R. Goldsmith, Kimberley A. Hirsch, Colette R. Peel, Alicia J. Rayner, Christopher Rimes, Katharine A. Saunders, Rob Wingrove, Janet Breen, Gerome Eley, Thalia C. Psychol Med Original Article 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. Cambridge University Press 2023-10 2022-12-13 /pmc/articles/PMC10520600/ /pubmed/36510471 http://dx.doi.org/10.1017/S0033291722003403 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
spellingShingle Original Article
Skelton, Megan
Carr, Ewan
Buckman, Joshua E. J.
Davies, Molly R.
Goldsmith, Kimberley A.
Hirsch, Colette R.
Peel, Alicia J.
Rayner, Christopher
Rimes, Katharine A.
Saunders, Rob
Wingrove, Janet
Breen, Gerome
Eley, Thalia C.
Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems
title Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems
title_full Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems
title_fullStr Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems
title_full_unstemmed Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems
title_short Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems
title_sort trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10520600/
https://www.ncbi.nlm.nih.gov/pubmed/36510471
http://dx.doi.org/10.1017/S0033291722003403
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