Service Use, Drop-Out Rate and Clinical Outcomes: A Comparison Between High and Low Intensity Treatments in an IAPT Service

• Published in: Behavioural and cognitive psychotherapy Vol. 42; no. 6; pp. 747 - 759
• Main Authors: Chan, Stella W. Y., Adams, Malcolm
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.11.2014
• Subjects: Adult; Adult and adolescent clinical studies; Anxiety Disorders - epidemiology; Anxiety Disorders - psychology; Anxiety Disorders - therapy; Behavior therapy. Cognitive therapy; Biological and medical sciences; Clinical outcomes; Cognitive Therapy - methods; Cognitive Therapy - statistics & numerical data; Community Health Services - utilization; Depression; Depressive Disorder - epidemiology; Depressive Disorder - psychology; Depressive Disorder - therapy; Female; Health Services Accessibility - statistics & numerical data; Humans; Male; Medical sciences; Middle Aged; Mood disorders; Motivation; Patient Dropouts - psychology; Patient Dropouts - statistics & numerical data; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Self Care - methods; Self Care - utilization; Surveys and Questionnaires; Treatments; Utilization Review; Young Adult; anxiety; depression; CBT; treatment outcome; drop-out; IAPT; Mood disorder; Human; Affect affectivity; Cognitive therapy; Treatment efficiency; Depression; Treatment; Anxiety; Behavior therapy; Comparative study
• ISSN: 1352-4658; 1469-1833; 1469-1833
• DOI: 10.1017/S1352465813000544

Background: The IAPT services provide high and low intensity psychological treatments for adults suffering from depression and anxiety disorders using a stepped care model. The latest national evaluation study reported an average recovery rate of 42%. However, this figure varied widely between services, with better outcomes associated with higher “step-up” rates between low and high intensity treatments. Aims: This study aimed to compare the two intensity groups in an IAPT service in Suffolk. Method: This study adopted a between groups design. A sample of 100 service users was randomly selected from the data collected from an IAPT service in Suffolk between May 2008 and February 2011. The treatment outcomes, drop-out rate, and other characteristics were compared between those who received high and low intensity treatments. Results: The high intensity group received, on average, more sessions and contact time. They received more CBT sessions and less guided self-help. There were no group differences in terms of the drop-out and appointment cancellation rates. Analyses on clinical outcomes suggested no group difference but demonstrated an overall recovery rate of 52.6% and significant reduction in both depression and anxiety symptoms. Conclusions: Despite methodological limitations, this study concludes that the service as a whole achieved above-average clinical outcomes. Further research building upon the current study in unpacking the relative strengths and weaknesses for the high and low intensity treatments would be beneficial for service delivery.