title: Deteriorated and unchanged patients in psychological treatment in Swedish primary care and psychiatry.
abstract: BACKGROUND
  Despite substantial effect sizes for psychological therapy among different diagnosis groups and in different treatment contexts, many studies show that a large proportion of patients do not attain reliable improvement and a substantial portion are worse off after treatment. Previous studies suggest that patients in psychiatry may have worse outcome than patients in primary care.
  
  
  OBJECTIVE
  In this practice-based study of psychological treatment in Swedish primary care and adult psychiatry, the proportions of patients who did not improve and who deteriorated were assessed.
  
  
  METHODS
  Proportions of reliably improved, unchanged, and reliably deteriorated patients among 840 patients in primary care and 317 patients in specialist psychiatry were assessed by self-ratings using the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM).
  
  
  RESULTS
  More than half of the patients did not change reliably. About 2% of the patients in primary care and 7% in psychiatry deteriorated. Multilevel analyses of the data from primary care indicated that there were no therapist effects.
  
  
  CONCLUSIONS
  The results emphasize the importance of monitoring treatment continuously in order to increase results for patients who do not improve.
authors.affiliation: a Jakob Mechler, Stockholms läns landsting, Norra Stockholms psykiatri , Sweden.
authors.forename: Jakob
authors.initials: J
authors.lastname: Mechler
authors.affiliation: b Rolf Holmqvist, Linköping University , Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Holmqvist
mesh_terms: D000328:Adult; D000368:Aged; D003156:Community Mental Health Services; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011320:Primary Health Care; D011613:Psychotherapy / Q000379:methods; D013548:Sweden; D017211:Treatment Failure
keywords: Adult specialist psychiatry; Deteriorated; Primary care; Treatment outcome; Unchanged