Firth, N. orcid.org/0000-0003-1984-6869, Barkham, M. orcid.org/0000-0003-1687-6376, Delgadillo, J. orcid.org/0000-0001-5349-230X et al. (2 more authors) (2023) The role of socioeconomic deprivation in explaining neighborhood and clinic effects in the effectiveness of psychological interventions. Journal of Consulting and Clinical Psychology, 91 (2). pp. 82-94. ISSN 0022-006X
Abstract
Objective: Treatment outcomes are known to vary according to therapist and clinic/organization (therapist effect, clinic effect). Outcomes may also vary according to the neighborhood where a person lives (neighborhood effect), but this has not previously been formally quantified. Evidence suggests that deprivation may contribute to explaining such cluster effects. This study aimed to 1) simultaneously quantify neighborhood, clinic, and therapist effects on intervention effectiveness, and 2) determine the extent to which deprivation variables explain neighborhood and clinic effects.
Method: The study used a retrospective, observational cohort design, with a high intensity psychological intervention sample (N = 617,375), and a low intensity psychological intervention sample (N = 773,675). Samples each included 55 clinics, 9,000-10,000 therapists/practitioners and 19,000+ neighborhoods in England. Outcomes were post-intervention depression and anxiety scores, and clinical recovery. Deprivation variables included individual employment status, domains of neighborhood deprivation, and clinic-level mean deprivation. Data were analyzed using crossclassified multilevel models.
Results: Unadjusted neighborhood effects of 1-2% and unadjusted clinic effects of 2-5% were detected, with proportionally larger effects for low intensity interventions. Deprivation variables explained a significant proportion of the neighborhood effect, but not clinic effect. The majority of neighborhood variance could only be explained by a shared effect of baseline severity and socioeconomic deprivation variables.
Conclusions: People in different neighborhoods respond differently to psychological intervention, with this clustering effect mainly explained by socioeconomic factors. People also respond differently according to the clinic they access, but this could not be completely explained by deprivation in the current study.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022 American Psychological Association. This is an author-produced version of a paper subsequently published in Journal of Consulting and Clinical Psychology. This version is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0). |
Keywords: | deprivation; neighborhood effect; therapist effect; organization effect; IAPT |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research The University of Sheffield > Faculty of Science (Sheffield) > Department of Psychology (Sheffield) |
Funding Information: | Funder Grant number DEPARTMENT OF HEALTH AND SOCIAL CARE ICA-CDRF-2018-04-ST2-043 National Institute for Health Research ICA-CDRF-2018-04-ST2-043 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 06 Dec 2022 16:48 |
Last Modified: | 29 Mar 2023 16:49 |
Status: | Published |
Publisher: | American Psychological Association |
Refereed: | Yes |
Identification Number: | 10.1037/ccp0000784 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:194119 |