Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence

Abstract

Objectives Improving Access to Psychological Therapies (IAPT) is a national‐level dissemination programme for provision of evidence‐based psychological treatments for anxiety and depression in the United Kingdom. This paper sought to review and meta‐analyse practice‐based evidence arising from the programme. Design A pre‐registered (CRD42018114796) systematic review and meta‐analysis. Methods A random effects meta‐analysis was performed only on the practice‐based IAPT studies (i.e. excluding the clinical trials). Subgroup analyses examined the potential influence of particular methodologies, treatments, populations, and target conditions. Sensitivity analyses investigated potential sources of heterogeneity and bias. Results The systematic review identified N = 60 studies, with N = 47 studies suitable for meta‐analysis. The primary meta‐analysis showed large pre‐post treatment effect sizes for depression (d = 0.87, 95% CI [0.78–0.96], p < .0001) and anxiety (d = 0.88, 95% CI [0.79–0.97], p < .0001), and a moderate effect on functional impairment (d = 0.55, 95% CI [0.48–0.61], p < .0001). The methodological features of studies influenced ESs (e.g., such as whether intention‐to‐treat or completer analyses were employed). Conclusions Current evidence suggests that IAPT enables access to broadly effective evidence‐based psychological therapies for large numbers of patients. The limitations of the review and the clinical and methodological implications are discussed. Practitioner points IAPT interventions are associated with large pre‐post treatment effect sizes in depression and anxiety measures. IAPT interventions are associated with moderate treatment effect sizes with regards to work and social adjustment. A reduction in dropout and also the prevention of post‐treatment relapse via the offer of follow‐up support are important areas for future development.

Ensuring that the Improving Access to Psychological Therapies (IAPT) programme does what it says on the tin

“…Wakefield et al . (2020) were strangely mute on this point. They similarly failed to acknowledge that the ‘IAPT’s studies’ involved no independent assessment of IAPT client’s functioning and there was no use of a ‘gold standard’ diagnostic interview.…”

“…In the Wakefield et al . (2020) paper all the authors declare ‘no conflict of interest’. But the corresponding author of the study, Stephen Kellett, is an IAPT Programme Director.…”

“…Whilst an IAPT study is conducted by a body or individual without a vested interest, in this connection Wakefield et al . (2020) have implicitly misclassified this author’s IAPT study, Scott (2018). In their study, Wakefield et al .…”

“…In their study, Wakefield et al . (2020) make reference to the Scott (2018) study with a focus on a subsample of 29 clients (from the 90 IAPT clients) for whom psychometric test results were available in the GP records. But in Scott (2018) it was made clear that concluding anything from such a subsample was extremely hazardous.…”

“…The Wakefield et al . (2020) study did not include a comparison of IAPT’s claimed outcomes with an appropriate counterfactual. For a new service to warrant continued funding, it must demonstrate that it is better than if the service never existed.…”