The Leeds Risk Index: Field-test of a stratified psychological treatment selection algorithm

Clinical guidelines for the treatment of depression and anxiety recommend psychological interventions organised in a stepped care model, where patients initially access low intensity guided self-help followed by high intensity psychotherapies if their symptoms persist. The Leeds Risk Index (LRI) is a data-driven tool that enables clinicians to profile patients into subgroups with low, moderate or high risk of poor response to treatment. A prior retrospective analysis of routine care data suggested that clinical outcomes for high risk cases could be improved by directly assigning them to high intensity treatments (stratified care) rather than usual stepped care. This study was the first prospective field-test of a stratified treatment selection approach based on the LRI tool. Post-treatment depression (PHQ-9) and anxiety (GAD-7) remission rates, dropout rates and treatment duration were compared between 157 stratified care cases vs. 125 stepped care controls. The results indicate that stratified care significantly improved the efficiency of psychological treatment, attaining comparable clinical outcomes in a shorter overall treatment duration.