title: Implementation of psychological therapies for anxiety and depression in routine practice: two year prospective cohort study.
abstract: BACKGROUND
  Worldwide, health systems are improving access to empirically supported psychological therapies for anxiety and depression. Evaluations of this effort are limited by the cross sectional nature of studies, short implementation periods, poor data completeness rates and lack of clinically significant and reliable change metrics.
  
  
  OBJECTIVE
  Assess the impact of implementing stepped care empirically supported psychological therapies by measuring the prospective outcomes of patients referred over a two year period to one Improving Access to Psychological Therapies service in the UK.
  
  
  METHODS
  We collected demographic, therapeutic and outcome data on depression (PHQ-9) and anxiety (GAD-7) from 7859 consecutive patients for 24 months between 1st July 2006 and 31st August 2008, following up these patients for a further one year.
  
  
  RESULTS
  4183 patients (53%) received two or more treatment sessions. Uncontrolled effect size for depression was 1.07 (95% CI: 0.88 to 1.29) and for anxiety was 1.04 (0.88 to 1.23). 55.4% of treated patients met reliable improvement or reliable and clinically significant change criteria for depression, 54.7% for anxiety. Patients received a mean of 5.5 sessions over 3.5h, mainly low-intensity CBT and phone based case management. Attrition was high with 47% of referrals either not attending for an assessment or receiving an assessment only.
  
  
  CONCLUSIONS
  Recovery rates for patients receiving stepped care empirically supported treatments for anxiety and depression in routine practice are 40 to 46%. Only half of all patients referred go on to receive treatment. Further work is needed to improve routine engagement of patients with anxiety and depression.
authors.affiliation: Mood Disorders Centre, College of Life and Environmental Science, University of Exeter, Exeter EX4 4QG, United Kingdom. D.A.Richards@exeter.ac.uk
authors.forename: David A
authors.initials: DA
authors.lastname: Richards
authors.forename: Gunilla
authors.initials: G
authors.lastname: Borglin
mesh_terms: D000328:Adult; D001007:Anxiety / Q000628:therapy; D001008:Anxiety Disorders / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000628:therapy; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013689:Telephone; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult