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Hunt VJ, Delgadillo J. Is alcohol use associated with psychological treatment attendance and clinical outcomes? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:527-540. [PMID: 34709665 DOI: 10.1111/bjc.12343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate associations between alcohol use, psychological treatment attendance, and clinical outcomes. METHODS We analysed electronic health records for N = 7,986 patients accessing psychological treatment for common mental disorders. Data were collected for pre-treatment alcohol use (average units per week) and severity of dependence (SDS), number of therapy contacts attended, pre- and post-treatment anxiety (GAD-7), and depression (PHQ-9) symptom severity. Hierarchical regression was used to examine associations between alcohol use/dependence and post-treatment symptom severity controlling for intake severity and relevant confounders. RESULTS After controlling for confounders, alcohol use had significant nonlinear associations with pre-treatment depression severity (R2 = .54, p < .01, cubic trend), and post-treatment anxiety (R2 = .23, p < .01, quadratic trend). Alcohol use was not significantly associated with intake anxiety, post-treatment depression or treatment duration. SDS was not significantly associated with depression severity, alcohol severity, or total contacts after controlling for confounders. CONCLUSION Alcohol users are just as likely to engage in and benefit from evidence-based psychological treatments for depression in primary care. A nonlinear association between alcohol use and anxiety treatment outcomes indicates that light-to-moderate drinkers have some shared characteristic that favours treatment response. PRACTITIONER POINTS Depression and anxiety problems often co-occur with alcohol use and dependence. Conventional wisdom in the field suggests that heavy alcohol users may not engage well or benefit from psychological therapies for depression and anxiety. We found no empirical support for the above assumptions in a large clinical sample. Alcohol consumption was not significantly associated with treatment attendance or depression treatment outcomes. A nonlinear association between alcohol use and anxiety outcomes suggests that moderate drinkers may have some shared characteristic that favours treatment response.
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Affiliation(s)
- Vanessa J Hunt
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, UK
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2
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Wakefield S, Kellett S, Simmonds‐Buckley M, Stockton D, Bradbury A, Delgadillo J. Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 60:1-37. [DOI: 10.1111/bjc.12259] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 05/14/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Sarah Wakefield
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
| | - Stephen Kellett
- University of Sheffield and Sheffield Health and Social Care NHS Foundation Trust UK
| | | | | | - Abigail Bradbury
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
| | - Jaime Delgadillo
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
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3
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Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2020; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
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Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
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Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2019; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 02/15/2024] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
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Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
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Murphy D, Turgoose D. Evaluating an Internet-based video cognitive processing therapy intervention for veterans with PTSD: A pilot study. J Telemed Telecare 2019; 26:552-559. [PMID: 31208264 DOI: 10.1177/1357633x19850393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION There remain a number of UK military veterans who are not able to access psychological therapies for post-traumatic stress disorder (PTSD). Some of these barriers are practical, including the need to balance work and other life commitments with attendance at residential or outpatient appointments. There is a need to investigate more accessible and flexible methods of delivering psychological therapies to veterans. One such alternative is to use remote-access video technology, often referred to as tele-therapy. The aims of the present study were to explore the feasibility of using tele-therapy in this population, whilst also reporting mental health outcomes for those who accessed the intervention. METHODS Participants were recruited from a UK veterans mental health charity. The intervention consisted of 12 sessions of cognitive processing therapy delivered via Skype. Participants completed various measures of mental health, including PTSD at three time points: pre-treatment, post-treatment and at three months follow-up. A measure of therapeutic alliance was also completed by participants and the clinician. RESULTS A total of 27 participants engaged in tele-therapy, with a treatment completion rate of 79% and a 'did not attend' rate of 12%, which compared well against similar outpatient services. All mental health outcomes showed maintained improvement at three months follow-up, with the highest effect size recorded for PTSD. Therapeutic alliance was also rated highly by both participants and the clinician. DISCUSSION The findings suggest that tele-therapy could provide a viable alternative format for delivering trauma-focused psychological therapies to veterans. Limitations and recommendations for future research are also presented.
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Affiliation(s)
- Dominic Murphy
- Combat Stress, King's Centre for Military Health Research, Leatherhead, Surrey, UK
| | - David Turgoose
- Combat Stress, King's Centre for Military Health Research, Leatherhead, Surrey, UK
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6
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Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2019; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2019] [Indexed: 02/15/2024] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 13 RCTs were found to meet inclusion criteria. The Dep-GP database was formed from the 6271 participants. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
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Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
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7
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Finnegan A, Jackson R, Simpson R. Finding the Forgotten: Motivating Military Veterans to Register with a Primary Healthcare Practice. Mil Med 2018; 183:e509-e517. [DOI: 10.1093/milmed/usy086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/10/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alan Finnegan
- Westminster Centre for Research and Innovation in Veterans’ Wellbeing, Faculty of Health and Social Services, University of Chester, Riverside Campus (Rm 311) – Castle Drive, Chester CH1 1SL, UK
| | - Robin Jackson
- NHS Bury Clinical Commissioning Group, 21 Silver Street, Bury, UK
| | - Robin Simpson
- Ministry of Defence Deanery, The Keep, Whittington Barracks, Lichfield, Staffordshire WS14 9PY, UK
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