title: Different people respond differently to therapy: A demonstration using patient profiling and risk stratification.
abstract: BACKGROUND
  This study aimed to identify patient characteristics associated with poor outcomes in psychological therapy, and to develop a patient profiling method.
  
  
  METHODS
  Clinical assessment data for 1347 outpatients was analysed. Final treatment outcome was based on reliable and clinically significant improvement (RCSI) in depression (PHQ-9) and anxiety (GAD-7) measures. Thirteen patient characteristics were explored as potential outcome predictors using logistic regression in a cross-validation design.
  
  
  RESULTS
  Disability, employment status, age, functional impairment, baseline depression and outcome expectancy predicted post-treatment RCSI. Regression coefficients for these factors were used to derive a weighting scheme called Leeds Risk Index (LRI), used to assign risk scores to individual cases. After stratifying cases into three levels of LRI scores, we found significant differences in RCSI and treatment completion rates. Furthermore, LRI scores were significantly correlated with the proportion of treatment sessions classified as 'not on track'.
  
  
  CONCLUSIONS
  The LRI tool can identify cases at risk of poor progress to inform personalized treatment recommendations for low and high intensity psychological interventions.
authors.affiliation: Leeds Community Healthcare NHS Trust, and Department of Health Sciences, University of York, UK. Electronic address: jaime.delgadillo@nhs.net.
authors.forename: Jaime
authors.initials: J
authors.lastname: Delgadillo
authors.affiliation: Centre for Clinical Practice, National Institute for Health and Care Excellence, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Moreea
authors.affiliation: Department of Psychology, University of Trier, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lutz
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Anxiety; Depression; IAPT; Patient profiling; Risk stratification