Long-term outcomes of Prompt Mental Health Care: A randomized controlled trial

Sæther, Solbjørg Makalani Myrtveit; Knapstad, Marit; Grey, Nick; Rognerud, Marit; Smith, Otto Robert Frans

doi:10.1016/j.brat.2020.103758

Cited by 4 publications

(8 citation statements)

References 77 publications

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The substantial intervention effect of PMHC compared to TAU on functioning, maintained at 12 months [23] and even further improved in the PMHC group at 24 and 36 months [41], is in itself worth mentioning and lends support for IAPT-like services as viable treatment alternatives for anxiety and depression. It should nonetheless be noted that the estimated intervention effects on symptoms were larger than the effect on functioning [21, 23]. This was the case at both 6- and 12-month follow-up and is in line with findings from previous studies, suggesting that CBT alone may not be sufficient to match improvements in functioning with improvements in symptoms [42, 43].…”

Section: Discussionmentioning

confidence: 99%

“…PMHC is the Norwegian adaptation of the English program Improving Access to Psychological Therapies (IAPT) [22] and is a free-of-charge, low-threshold, primary health care program aimed at reaching adults with anxiety and mild-to-moderate levels of depression. We have previously shown that PMHC treatment, in comparison with a treatment-as-usual condition, is effective in terms of reducing symptom levels of anxiety and depression and improving functioning at both 6- and 12-month follow-up [21, 23]. Design, study setting, recruitment, randomization, and interventions were described in detail in an earlier article that presented the main findings of the trial [21].…”

Section: Methodsmentioning

confidence: 99%

“…For all outcomes, the average improvement was greater for participants assigned to the PMHC group compared to those assigned to the TAU group. Formal effect estimates are presented elsewhere [21,23]. largely explained by the intervention effect on depressive symptoms at 6-month follow-up (70.0%, adjusted analysis).…”

Section: Descriptive Statisticsmentioning

confidence: 99%

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The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

Smith¹,

Aarø²,

Knapstad³

2023

Psychother Psychosom

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Introduction: The temporal relationship between symptoms and functioning in the context of cognitive behavioral therapy (CBT) for anxiety and depression is not fully understood, and there are few high-quality studies that have examined to what extent late intervention effects of CBT on functioning are mediated by initial intervention effects on symptoms while accounting for the initial effects on functioning and vice versa. Objective: The aim of the study was to investigate whether intervention effects on symptoms and functioning at 12-month follow-up were mediated by intervention effects on these outcomes at 6-month follow-up. Methods: Participants with anxiety and/or mild-to-moderate depression were randomly assigned to a primary mental health care service (n = 463) or treatment-as-usual (n = 215). Main outcomes were depressive symptoms (Patient Health Questionnaire [PHQ-9]), anxiety (General Anxiety Disorder-7 [GAD-7]), and functioning (Work and Social Adjustment Scale [WSAS]). Direct/indirect effects were derived using the potential outcomes and counterfactual framework. Results: The intervention effect on functioning at 12 months was largely explained by intervention effects at 6 months on depressive symptoms (51%) and functioning (39%). The intervention effect on depressive symptoms at 12 months was largely explained by the intervention effect at 6 months on depressive symptoms (70%) but not by functioning at 6 months. The intervention effect on anxiety at 12 months was only partly accounted for by intervention effects at 6 months on anxiety (29%) and functioning (10%). Conclusions: The findings suggest that late intervention effects of CBT on functioning were to a substantial degree explained by initial intervention effects on depressive symptoms even after accounting for initial effects on functioning. Our results support the importance of symptoms as an outcome in the context of CBT delivered in primary health care.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Descriptive Statisticsmentioning

confidence: 99%

See 3 more Smart Citations

The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

Smith¹,

Aarø²,

Knapstad³

2023

Psychother Psychosom

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Social anxiety and agoraphobia symptoms effectively treated by Prompt Mental Health Care versus TAU at 6‐ and 12‐month follow‐up: Secondary analysis from a randomized controlled trial

Knapstad

Smith

2021

Depression and Anxiety

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Background Prompt Mental Health Care (PMHC, Norwegian adaption of Improving Access to Psychological Therapies) has shown effects on symptoms of anxiety and depression compared to treatment as usual (TAU). In this secondary analysis, we examine the effectiveness of PMHC among clients presenting with symptoms of social anxiety disorder (SAD) and/or agoraphobia on core symptoms at 6‐ and 12‐month follow‐up. Methods Randomized controlled trial in two PMHC sites (70:30 ratio PMHC:TAU). Of participants, 61.3% (n = 472) scored at caseness for SAD and 47.7% (n = 367) for agoraphobia (40% both). Effects on SAD avoidance and physiological discomfort (SPIN‐9), SAD cognitions (ATQ‐SA), agoraphobic avoidance (MIA‐8), and agoraphobic cognitions (ATQ‐AP) were examined in piecewise growth models. Results The PMHC group showed substantially greater symptom reduction than the TAU group for all outcomes: At 6‐month follow‐up, the between‐group effect sizes were d −0.60 (95% CI: −0.94 to −0.26) for SPIN‐9, −0.45 (95% CI: −0.70 to −0.20) for ATQ‐SA, −0.50 (95% CI: −0.87 to −0.13) for MIA‐8, and −0.61 (95% CI: −0.92 to −0.31) for ATQ‐AP. All effects were sustained at similar level at a 12‐month follow‐up. Conclusion PMHC effectively alleviated SAD and agoraphobia symptoms, and individuals struggling with such symptoms constituted a large proportion of clients. Although results should be interpreted with caution due to risk of attrition bias, they lend further support for a scale‐up of PMHC and similar initiatives. Individuals struggling with SAD and/or agoraphobia stood out as relatively high burdened, whereas only one of five had sought help the last 12 months, underscoring the need for the PMHC service.

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Long-term outcomes at 24- and 36-month follow-up in the intervention arm of the randomized controlled trial of Prompt Mental Health Care

et al. 2022

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Background Whether long-term symptom improvement is maintained after treatment in services such as the Norwegian Prompt Mental Health Care (PMHC) and the English Improving Access to Psychological Therapies is not yet known. In this prospective study, we investigate whether improvements observed at 6-month follow-up are maintained at 24- and 36-month follow-up among clients who received PMHC. Method Data from the treatment arm of the randomized controlled trial of PMHC were used (n = 459). The main outcomes were (reliable) recovery rate and symptoms of depression (PHQ-9) and anxiety (GAD-7). Primary outcome data at 24- and 36-months follow-up were available for 47% and 39% of participants, respectively. Secondary outcomes were work participation, functional status, health-related quality of life, and positive mental well-being. Sensitivity analyses with regard to missing data assumptions were conducted for the primary continuous outcomes. Results Improvements were maintained at 24- and 36-month follow-up for symptoms of depression and anxiety, (reliable) recovery rate, and health-related quality of life. Small linear improvements since 6-month follow-up were observed for work participation, functional status, and positive mental well-being. Sensitivity analyses did not substantially alter the findings for symptoms of depression and anxiety mentioned above. Conclusions Our findings support the long-term effectiveness of PMHC, but results should be interpreted with caution due to lacking follow-up data at 24- and 36-month in the control group, and substantial attrition.

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Long-term outcomes of Prompt Mental Health Care: A randomized controlled trial

Cited by 4 publications

References 77 publications

The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

Social anxiety and agoraphobia symptoms effectively treated by Prompt Mental Health Care versus TAU at 6‐ and 12‐month follow‐up: Secondary analysis from a randomized controlled trial

Long-term outcomes at 24- and 36-month follow-up in the intervention arm of the randomized controlled trial of Prompt Mental Health Care

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