Mental health outcomes in patients with a long-term condition: analysis of an IAPT service, 2022, Moss-Morris et al

Abstract
Background: Having a long-term condition (LTC) significantly affects mental health. UK policy requires effective mental health provisions for patients with an LTC, generally provided by Improving Access to Psychological Therapies (IAPT) services. National IAPT data suggest that patients with an LTC typically demonstrate poorer outcomes compared with patients without an LTC. However, exploration of confounding factors and different outcome variables is limited.

Aims: To establish the association of LTC status with demographic and clinical factors, and clinical mental health outcomes.

Method: Anonymised patient-level data from a London IAPT service during January 2019 to October 2020 were used in this cohort study, to compare differences between LTC and non-LTC groups on sociodemographic and clinical variables. Binary logistic and multiple linear regression models were constructed for binary outcome variables (recovery and reliable improvement) and continuous outcomes (distress and functioning), respectively.

Results: Patients with an LTC were more likely to be female; older; from a Black, mixed or other ethnic background; and have greater social deprivation. Across the four clinical outcomes (recovery, reliable improvement, final psychological distress and final functioning), having an LTC significantly predicted poorer outcomes even after controlling for sociodemographic and clinical baseline variables. For three outcome variables, greater social deprivation and being discharged during the COVID-19 pandemic also predicted poorer clinical outcomes.

Conclusions: LTC status has a negative effect on mental health outcomes in IAPT services, independent of associated variables such as severity of baseline mental health symptoms, ethnicity and social deprivation. Effective psychological treatment for patients with an LTC remains an unresolved priority.

https://www.cambridge.org/core/jour...pies-service/541E3611F5AC8EA4E19911C4FEC4B645

 

That is a description of the people most likely to be disbelieved and gaslighted by doctors. Anyone who has suffered from excruciating pain with no treatment, repeatedly over the course of years, is likely to struggle with their mental health, and depression and anxiety are likely to be common. It appals me that doctors think that making patients mentally "tougher" so they can cope better with their excruciating pain is the right way to fix their problems.

 

Absolutely agreed @Trish and @Arnie Pye.


How about being logical? For groups with less stigma, little to no medical gaslighting, good health, good incomes, nice homes, etc., psychological problems could be more amenable to counseling.

Common sense would say with less advantages, and a debilitating chronic illness, one's circumstances may impede becoming happy and jolly.

Practical problems, at least partially alleviated by increased social assistance funds, provision of enough and good social housing, respect, medical and social care and belief, are more likely to improve the outlook of the people not well served by counseling.

 

Let me guess, this will lead to increased funding for IAPT. As it tradition in EBM, when the evidence doesn't confirm the aspirations, it's just ignored or interpreted in a way that blames some random thing out there.

Don't know if anyone watched the West Wing but this is genuinely "illness, boy, I don't know" level of WTF? Illness is bad, no one likes being ill, this isn't hard, in fact it's so easy even children understand this. It takes years of bad education to unlearn something as simple as this.

And all because they simply refuse to accept what the patients are reporting. All this needless suffering out of rejecting reality and substituting their own.

This is all exactly like the issue of poverty and how all evidence shows that just giving poor people money with no strings attached has by far the best RoI, and still social programs are always based on being punishing. If you solve the cash problem, you solve the poverty problem. If you solve the illness problem, you solve the impacts of illness. This is as easy as it should be, and yet there's this.

 

In the UK it is established that poverty is not caused by a lack of money, it's caused by not working enough hours. If you can't survive on 40 hours pay then work 60 hours, if that still isn't enough then work 80, etc.

So simply giving 'poor' people more money clearly isn't the answer, to the problem which is seen as being them not working enough hours.

Obviously disability isn't seen as a 'thing' here so it, and any reduction in ability to work 120 hours a week, cannot be a factor in disabled poverty.

So no money there either.

'We' have the same views on crime - not caused by poverty, and homelessness - not caused by a lack of affordable housing.

Cloud cuckoo land is a wonderful place

 

I have not looked at the paper itself, but I assume much of the measuring of outcomes was by existing mental health questionnaires that fail to distinguish between mental health issues that limit people’s life and physical health issues that restrict what they are physically able to do. If this is the case there is no wonder that people with long term conditions given talking therapies improve less than people with genuine mental health issues.

Those with long term conditions are mis scored as having mental health issues, and then unsurprisingly do not improve on those scores after treatment for mental health issues that ignores their real biomedical condition.

 

It's just an unkind and unscientific or even logical 'solution' to a 'problem' come up with by narcissists who like to use phrases like 'playing the victim' whilst normally engaging in antisocial or inconsiderate behaviour towards said person.

When I was doing my BSc Psychology I would say that this isn't psychology or what the science thinks - biopsychosocial model was a weird outlier nodded to as a 'and we have to add this one in for you to know exists but it makes no sense' only in clinical, and I suspect was one of the ones in another module covered by "there are some areas that we have to hound out of the subject using science then it reinvents itself and we have to do it all over again every 20yrs or so".

I was led to believe that the science of psychology was set up due to the 'emergency' in the pseudo-psych of psychiatry and clinical at that time, in order to bring some proper rigour to looking at the brain and bring some credibility where anything was worth it by itself getting rid of the nonsense. I also got the sense that there is a power struggle between psychiatry and psychologists (scientific sense not clinical in research club/orthodoxy terms you might assume) - as one didn't want to be 'audited by the other'.

Which explains a lot of the IAPTs etc moves in the last 20yrs moving into taking power from having psychologists who diagnose and match treatment (even half way through) to doctors flinging off who they want and only having 'CBT deliverers' who can't correct misdiagnoses or decide better.

I very much see the biopsychosocial and it's 'non causal' model - which is highly unusual compared to all other models there at the time - as being one which in its newer form has basically been used to write down ideologies and biases and values that were just 'of the doctor/nurse profession' to pretend they were psychology rather than passed down systemic attitudes and presumptions.

All these factors make someone ill getting shoved off to IAPTS, often without being heard with a claim of 'just in case, because I can't diagnose or not diagnose you' to find that once in IAPT 'they assume you've been sent there because you have x' and then finding the implications for getting anywhere with any alternatives of having such a mislabel and often by proxy their voice removed from being heard even more, is devastating. I'd go so far as the 'whole system' in that way being 'logically, a way to create psychological harm/haunting' by any normal psychological model.

Adding in the idea that others bullying you or problems in other areas (bad housing etc) are reframed to be 'your perception' also emboldens others to make those worse, by blaming the victim suggesting they are just 'a complainer' and handing over permission. These things which normally are the primary tenets of a psychological model which would start with situational variables (as often once these removed there is no issues) and sorting them, means that for anything with that component (most with LTC) it is designed to create harm by weakening their right to solve it, or even claim black is black on reality of what the cause is vs a model saying 'just see it more positively'.

I find it outrageous how this is beyond psychology and has in 20yrs changed into a charter whereby antisocials and people doing things that could cause 'injury' of some sort are being emboldened to do what they like and blame the person affected as being 'too negative', 'don't complain', 'look at it differently and it won't be so bad' etc. All just phrases we used to see for what they are.