title: Impact of long-term medical conditions on the outcomes of psychological therapy for depression and anxiety.
abstract: Long-term conditions often coexist with depression and anxiety.
  
  
  
  To assess the effectiveness of stepped-care psychological therapies for patients with long-term conditions.
  
  
  
  Data from 28 498 patients were analysed using regression to model depression (Patient Health Questionnaire (PHQ-9)) and anxiety (Generalised Anxiety Disorder scale (GAD-7)) outcomes. Post-treatment symptoms and effect sizes (d) were estimated for individuals with and without long-term conditions, controlling for covariates. The likelihood of access and response to intensive psychological interventions was also examined.
  
  
  
  Higher post-treatment symptoms were predicted for patients with musculoskeletal problems (d = 0.22-0.27), chronic obstructive pulmonary disease (d = 0.26-0.33), diabetes (d = 0.05-0.13) and psychotic disorders (d = 0.50-0.58). Most long-term conditions were associated with greater odds of accessing high-intensity therapies, yet individuals who accessed these continued to have higher average post-treatment symptoms.
  
  
  
  Some long-term conditions are associated with greater intensity of care and poorer outcomes after therapy.
authors.affiliation: Jaime Delgadillo, PhD, Leeds Community Healthcare NHS Trust and Department of Health Sciences, University of York, York, UK; Alexander Dawson, Leeds Community Healthcare NHS Trust, Leeds; Simon Gilbody, DPhil, FRCPsych, Jan R. Böhnke, Dipl Psych, Dr rer nat, Hull York Medical School, and Department of Health Sciences, University of York, York, UK jaime.delgadillo@nhs.net.
authors.forename: Jaime
authors.initials: J
authors.lastname: Delgadillo
authors.affiliation: Jaime Delgadillo, PhD, Leeds Community Healthcare NHS Trust and Department of Health Sciences, University of York, York, UK; Alexander Dawson, Leeds Community Healthcare NHS Trust, Leeds; Simon Gilbody, DPhil, FRCPsych, Jan R. Böhnke, Dipl Psych, Dr rer nat, Hull York Medical School, and Department of Health Sciences, University of York, York, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Dawson
authors.affiliation: Jaime Delgadillo, PhD, Leeds Community Healthcare NHS Trust and Department of Health Sciences, University of York, York, UK; Alexander Dawson, Leeds Community Healthcare NHS Trust, Leeds; Simon Gilbody, DPhil, FRCPsych, Jan R. Böhnke, Dipl Psych, Dr rer nat, Hull York Medical School, and Department of Health Sciences, University of York, York, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: Jaime Delgadillo, PhD, Leeds Community Healthcare NHS Trust and Department of Health Sciences, University of York, York, UK; Alexander Dawson, Leeds Community Healthcare NHS Trust, Leeds; Simon Gilbody, DPhil, FRCPsych, Jan R. Böhnke, Dipl Psych, Dr rer nat, Hull York Medical School, and Department of Health Sciences, University of York, York, UK.
authors.forename: Jan R
authors.initials: JR
authors.lastname: Böhnke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000453:epidemiology; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011613:Psychotherapy / Q000379:methods*; D011618:Psychotic Disorders / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D055815:Young Adult