Evaluation of NHS Practitioner Health: capturing mental health outcomes using five instruments

BACKGROUND: NHS Practitioner Health is the England wide programme providing mental health and addiction healthcare to doctors and dentists. Outcomes are assessed using five measures. AIMS: To contribute to a service evaluation of NHS Practitioner Health. To determine responsiveness to change and compare outcome measures. METHOD: Measures were completed at baseline and 6 months: Generalized Anxiety Disorder Assessment (GAD-7), Perceived Stress Scale (PSS), Patient Health Questionaire-9 (PHQ-9), Warwick-Edinburgh Mental Wellbeing scale (WEMWBS), Psychological Outcome Profiles (PSYCHLOPS). Responsiveness to change was determined using effect size with improvement threshold ≥0.80. Instruments were compared using Bland–Altman plots. RESULTS: Our sample, n = 402; with 14 (3.5%) excluded for missing data; final sample, n = 388. All measures showed strong mean effect sizes: PSYCHLOPS 1.86 (95%CI 1.73–1.99), 75.8% ≥0.80; PSS 1.48 (1.34–1.62), 64.4% ≥0.80; WEMWBS 1.24 (1.13–1.35), 58.2% ≥0.80; GAD-7 1.07 (0.96–1.18), 52.8% ≥0.80; PHQ-9 0.86 (0.76–0.96), 52.8% ≥0.80. Findings were largely unchanged after stratification by diagnosis, presenting problem or therapy type. Fifty (12.9%) participants did not reach the threshold for improvement on any instrument. Bland–Altman plots indicated generally strong agreement between measures; combining PSYCHLOPS with WEMWBS maximised capture of improvement with only 3.6% of patients lying outside limits of agreement; GAD-7 was most likely to duplicate recovery scores of other measures. CONCLUSIONS: Patients attending the NHS Practitioner Health service demonstrated high levels of improvement in mental health scores. The patient-generated instrument produced higher change scores than standardised instruments. Combining PSYCHLOPS and WEMWBS captured 96% of patients with above threshold improvement; GAD-7 added little to overall recovery measurement.