Estimating the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) service addressing the wider determinants of mental health: a real-world evaluation.

ABSTRACT

BACKGROUND: Addressing the wider determinants of mental health alongside psychological therapy could improve mental health service outcomes and population mental health. OBJECTIVES: To estimate the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) mental health service compared with traditional IAPT in England. Alongside traditional therapy treatment, the enhanced service included well-being support and community service links. DESIGN: A real-world evaluation using IAPT's electronic health records. SETTING: Three National Health Service IAPT services in England. PARTICIPANTS: Data from 17 642 service users classified as having a case of depression and/or anxiety at baseline. INTERVENTION We compared the enhanced IAPT service (intervention) to an IAPT service in a different region providing traditional treatment only (geographical control), and the IAPT service with traditional treatment before additional support was introduced (historical control). PRIMARY OUTCOME MEASURES: Patient Health Questionnaire-9 (PHQ-9) Depression Scale (score range 0-27) and Generalised Anxiety Disorder-7 (GAD-7) Anxiety Scale (score range 0-21); for both, lower scores indicate better mental health. Propensity scores were used to estimate inverse probability of treatment weights, subsequently used in mixed effects regression models. RESULTS: Small improvements (mean, 95% CI) were observed for PHQ-9 (depression) (-0.21 to -0.32 to -0.09) and GAD-7 (anxiety) (-0.23 to -0.34 to -0.13) scores in the intervention group compared with the historical control. There was little evidence of statistically significant differences between intervention control and geographical control. CONCLUSIONS: Embedding additional health and well-being (H&W) support into standard IAPT services may lead to improved mental health outcomes. However, the lack of improved outcomes compared with the geographical control may instead reflect a more general improvement to the intervention IAPT service. It is not clear from our findings whether an IAPT service with additional H&W support is clinically superior to traditional IAPT models.