Physical long-term conditions and psychological treatment outcomes in NHS talking therapies: prevalence, impact, and moderators

Objective

This study examined the impact of having one or multiple physical long-term conditions (LTCs) on treatment outcomes and engagement with NHS Talking Therapies (NHS-TT), focusing on clinical and treatment-related moderators.

Methods

A retrospective cohort design was applied to routine data from 44,957 patients discharged from seven NHS-TT services in Northwest England between September 2021 and September 2024. Logistic regression analyses assessed the impact of LTC status (none, one or multiple LTCs) on reliable recovery—defined as clinically significant improvement in both depression and anxiety scores—and treatment engagement, operationalised as planned discharge versus dropout. Moderation analyses explored the influence of provisional diagnosis, baseline functional impairment, treatment intensity and mode of therapy delivery.

Results

LTCs were reported by 47.5% of patients, with 9.4% reporting multiple LTCs. Patients with LTCs had lower odds of reliable recovery (OR = 0.83), with further reductions among those with multimorbidity (OR = 0.71). Conversely, LTC status was associated with higher odds of planned discharge (OR = 1.28). The negative association with reliable recovery was attenuated among patients with depression (OR = 1.21) but exacerbated for those with mixed anxiety and depression (OR = 0.71), who also had lower odds of planned discharge (OR = 0.66).

Conclusion

Multimorbidity is associated with poorer clinical outcomes despite higher treatment engagement. Tailored care pathways are needed to better support patients with LTCs.