Prompt Mental Health Care (PMHC): work participation and functional status at 12 months post-treatment

Abstract

Background: Anxiety and depression are associated with substantial functional impairment. Prompt Mental Health Care (PMHC), the Norwegian adaptation of IAPT is currently piloted across Norway, as a means to improve access to evidence-based care for adults with anxiety disorders (including subthreshold cases) and minor to moderate depression. The aims of the current paper were to examine the change in work status and functional status from pre-to post-treatment and 12 months post-treatment among clients at the first 12 PMHC pilot sites, and whether degree of change differed across sociodemographic characteristics. Methods: A prospective cohort design was used, including working age clients receiving treatment between October 2014 and December 2016 (n = 1446, participation rate = 61%). Work status and functional status were selfreported, the latter by the Work and Social Adjustment Scale (WSAS). Changes in work status and WSAS score were examined through multilevel models based on maximum likelihood estimation. Likelihood ratio tests were performed to determine whether the interaction between time and the respective background variables were statistically significant. Results: A substantial increase in regular work participation was observed from pre-to post-treatment, which further had increased at 12 months post-treatment. The increase was driven by a corresponding reduction in proportion of clients working and receiving benefits (OR 0.38 [0.29-0.50] baseline to final treatment, OR = 0.19 [0.12-0.32] final treatment to 12-months post-treatment), while no statistically significant change was observed in proportion out of work. Large improvement (ES = − 0.89) in WSAS score was observed from pre-to post treatment. WSAS score at 12 months post-treatment remained at the post-treatment level. Conclusions: Previous research has shown substantial symptom improvement among clients receiving treatment in PMHC. The current findings indicate that PMHC might also be able to aid adults struggling with mild to moderate anxiety and depression in returning to usual level of functioning. The degree to which the observed improvements are attributable to the treatment need nonetheless to be confirmed in a trial including a control group and with more complete follow-up data from registries.

Effects of rehabilitative psychotherapy on labour market success: Evaluation of a nationwide programme

“…The strengths of this study were its credible control group and its use of large register-based data, consisting of accurate information on the participants’ health and employment. The main results are qualitatively similar to those of prior studies with shorter follow-ups and different research designs [7,13–15]. As the target groups, programmes and outcome variables are somewhat different, it is not possible to directly compare the quantitative size of the effects to those in prior studies.…”

“…It is, therefore, crucial to obtain evidence on the effectiveness of treatment in different country contexts and in larger populations. Some evaluations are available from the US, Britain and the Nordic countries, suggesting that psychotherapy improves employment outcomes [13–15]. Our study contributes to this scarcely researched field by studying a Finnish nationwide subsidized psychotherapy programme using extensive register-based data.…”

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

“…This indicates that treatment gains at least in part are maintained beyond final treatment. In Norway, this has been confirmed; Improvement in symptoms of anxiety and depression, as well as functional status, observed at post-treatment in the PMHC pilot was in large maintained at 12 months post-treatment (Knapstad, Saether, Hensing, & Smith, 2020). Further, recovery rates decreased only slightly from 49.5% at post-treatment to 45.0% at 12 months post-treatment (Saether, Knapstad, Grey, & Smith, 2019).…”

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

“…A sum score ranging from 0 to 40 was created. The WSAS has been employed in previous evaluations of PMHC [29] and IAPT [30]. In this context, WSAS was found to have discriminant validity to, and comparable reliability and sensitivity to change as, the PHQ-9 and GAD-7 [31].…”