Evidence map›Paper›PMID 38296286›Full record

ArticleBMJ open2024

Estimating the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) service addressing the wider determinants of mental health: a real-world evaluation.

Alice Porter, Matthew Franklin, Frank De Vocht, Katrina d'Apice, Esther Curtin, Patricia Albers, Judi Kidger

Abstract read
In one paragraph

Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Alice PorterPopulation Health Sciences, University of Bristol, Bristol, UK alice.porter@bristol.ac.uk.ORCID 0000-0001-5281-7694
Matthew FranklinHealth Economic and Decision Science, The University of Sheffield, Sheffield, UK.ORCID 0000-0002-2774-9439
Frank De VochtPopulation Health Sciences, University of Bristol, Bristol, UK.
Katrina d'ApicePopulation Health Sciences, University of Bristol, Bristol, UK.
Esther CurtinPopulation Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Patricia AlbersPopulation Health Sciences, University of Bristol, Bristol, UK.
Judi KidgerPopulation Health Sciences, University of Bristol, Bristol, UK.ORCID 0000-0002-1054-6758

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAddressing the wider determinants of mental health alongside psychological therapy could improve mental health service outcomes and population mental health.

objectivesTo estimate the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) mental health service compared with traditional IAPT in England. Alongside traditional therapy treatment, the enhanced service included well-being support and community service links.

designA real-world evaluation using IAPT's electronic health records.

settingThree National Health Service IAPT services in England.

participantsData from 17 642 service users classified as having a case of depression and/or anxiety at baseline.

interventionWe compared the enhanced IAPT service (intervention) to an IAPT service in a different region providing traditional treatment only (geographical control), and the IAPT service with traditional treatment before additional support was introduced (historical control). PRIMARY OUTCOME MEASURES: Patient Health Questionnaire-9 (PHQ-9) Depression Scale (score range: 0-27) and Generalised Anxiety Disorder-7 (GAD-7) Anxiety Scale (score range: 0-21); for both, lower scores indicate better mental health. Propensity scores were used to estimate inverse probability of treatment weights, subsequently used in mixed effects regression models.

resultsSmall improvements (mean, 95% CI) were observed for PHQ-9 (depression) (-0.21 to -0.32 to -0.09) and GAD-7 (anxiety) (-0.23 to -0.34 to -0.13) scores in the intervention group compared with the historical control. There was little evidence of statistically significant differences between intervention control and geographical control.

conclusionsEmbedding additional health and well-being (H&W) support into standard IAPT services may lead to improved mental health outcomes. However, the lack of improved outcomes compared with the geographical control may instead reflect a more general improvement to the intervention IAPT service. It is not clear from our findings whether an IAPT service with additional H&W support is clinically superior to traditional IAPT models.

Indexed as

Mental HealthState MedicineAnxietyAnxiety DisordersEnglandHealth Services AccessibilityHumansAdult psychiatryElectronic Health RecordsMENTAL HEALTH

Identifiers

PMID38296286
PMCPMC10828880

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.