title: A retrospective observational analysis to identify patient and treatment-related predictors of outcomes in a community mental health programme.
abstract: OBJECTIVE
  This study aims to identify patient and treatment factors that affect clinical outcomes of community psychological therapy through the development of a predictive model using historic data from 2 services in London. In addition, the study aims to assess the completeness of data collection, explore how treatment outcomes are discriminated using current criteria for classifying recovery, and assess the feasibility and need for undertaking a future larger population analysis.
  
  
  METHODS
  Observational, retrospective discriminant analysis.
  
  
  METHODS
  2 London community mental health services that provide psychological therapies for common mental disorders including anxiety and depression.
  
  
  METHODS
  A total of 7388 patients attended the services between February 2009 and May 2012, of which 4393 (59%) completed therapy, or there was an agreement to end therapy, and were included in the study.
  
  
  METHODS
  Different combinations of the clinical outcome scores for anxiety Generalised Anxiety Disorder-7 and depression Patient Health Questionnaire-9 were used to construct different treatment outcomes.
  
  
  RESULTS
  The predictive models were able to assign a positive or negative clinical outcome to each patient based on 5 independent pre-treatment variables, with an accuracy of 69.4% and 79.3%, respectively: initial severity of anxiety and depression, ethnicity, deprivation and gender. The number of sessions attended/missed were also important factors identified in recovery.
  
  
  CONCLUSIONS
  Predicting whether patients are likely to have a positive outcome following treatment at entry might allow suitable modification of scheduled treatment, possibly resulting in improvements in outcomes. The model also highlights factors not only associated with poorer outcomes but inextricably linked to prevalence of common mental disorders, emphasising the importance of social determinants not only in poor health but also poor recovery.
authors.affiliation: NIHR CLAHRC Northwest London, Imperial College London, London, UK.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Green
authors.affiliation: Central and North West London NHS Foundation Trust, London, UK.
authors.forename: Emmi
authors.initials: E
authors.lastname: Honeybourne
authors.affiliation: NIHR CLAHRC Northwest London, Imperial College London, London, UK.
authors.forename: Sylvia R
authors.initials: SR
authors.lastname: Chalkley
authors.affiliation: NIHR CLAHRC Northwest London, Imperial College London, London, UK.
authors.forename: Alan J
authors.identifier: http://orcid.org/0000-0002-2331-0904
authors.initials: AJ
authors.lastname: Poots
authors.affiliation: NIHR CLAHRC Northwest London, Imperial College London, London, UK.
authors.forename: Thomas
authors.identifier: http://orcid.org/0000-0002-4735-4856
authors.initials: T
authors.lastname: Woodcock
authors.affiliation: Central and North West London NHS Foundation Trust, London, UK.
authors.forename: Geraint
authors.initials: G
authors.lastname: Price
authors.affiliation: NIHR CLAHRC Northwest London, Imperial College London, London, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Bell
authors.affiliation: Central and North West London NHS Foundation Trust, London, UK Department of Clinical Health Psychology, St. Marys Hospital, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000628:therapy*; D001008:Anxiety Disorders / Q000628:therapy*; D003156:Community Mental Health Services; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D003863:Depression / Q000628:therapy*; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D011613:Psychotherapy; D036301:Qualitative Research; D012111:Residence Characteristics; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: EPIDEMIOLOGY; MENTAL HEALTH