The impact of long term medical conditions on the outcomes of psychological therapy for depression and anxiety

Background: Long term conditions (LTC) often coexist with depression and anxiety. Aims: To assess the effectiveness of stepped care psychological therapies for patients with LTC. Method: Data from 28498 patients were analysed using regression to model depression (PHQ-9) and anxiety (GAD-7) outcomes. Post-treatment symptoms and effect sizes (d) were estimated for cases with and without LTC, controlling for covariates. The likelihood of access and response to intensive psychological interventions was also examined. Results: Higher post-treatment symptoms were predicted for patients with musculoskeletal problems (d = .22 to .27), COPD (d = .26 to .33), diabetes (d = .05 to .13) and psychotic disorders (d = .50 to .58). Most LTC were associated with greater odds of accessing high intensity therapies (HIT), yet HIT cases continued to have higher average post-treatment symptoms. Conclusions: Some LTC are associated with greater intensity of care and poorer outcomes after therapy.