Patient experience of lasting negative effects of psychological interventions for anxiety and depression in secondary mental health care services: a national cross-sectional study

Aisling Mcquaid,David S Baldwin,Alan Quirk,Lorna Farquharson,Prisha Shah,Rahil Sanatinia,Mike Crawford

doi:10.1186/s12888-021-03588-2

Abstract

BackgroundPatients who undergo psychological treatment can report both negative and positive effects, but evidence of factors influencing the likelihood of negative effects is limited.AimsTo identify aspects of the organisation and delivery of secondary care psychological treatment services that are associated with patient experiences of negative effects.MethodCross-sectional survey of people with anxiety and depression who ended psychological treatment delivered by 50 NHS trusts in England. Respondents were asked about how their treatment was organised and delivered and whether they experienced lasting negative effects.ResultsOf 662 respondents, 90 (14.1%) reported experiencing lasting negative effects. People over the age of 65 were less likely than younger respondents to report negative effects. There was an association between reporting neutral or negative effects and not being referred at what respondents considered to be the right time (OR = 1.712, 95% CI = 1.078–2.726), not receiving the right number of sessions (OR = 3.105, 95% CI = 1.934–4.987), and not discussing progress with their therapist (OR 2.063, 95% CI = 1.290–3.301).ConclusionsOne in seven patients who took part in this survey reported lasting negative effects from psychological treatment. Steps should be taken to prepare people for the potential for negative experiences of treatment, and progress reviewed during therapy in an effort to identify and prevent negative effects.

Highlights

One in six adults experience a common mental health problem such as anxiety and depression [1]
Steps should be taken to prepare people for the potential for negative experiences of treatment, and progress reviewed during therapy in an effort to identify and prevent negative effects
Patients with more severe conditions, those with complex difficulties associated with coexisting conditions, and people judged at high risk of suicide are treated by specialist teams based in secondary care mental health services

Summary

Introduction

One in six adults experience a common mental health problem such as anxiety and depression [1]. People with anxiety and depression experience emotional distress, reduced quality of life [2], and impaired social functioning [3]. Excellence in England recommend psychological interventions as first line treatments for anxiety and depression [4, 5]. In England, most people who undergo psychological treatment for anxiety and depression receive it in primary care. Patients with more severe conditions, those with complex difficulties associated with coexisting conditions, and people judged at high risk of suicide are treated by specialist teams based in secondary care mental health services. Patients who undergo psychological treatment can report both negative and positive effects, but evidence of factors influencing the likelihood of negative effects is limited

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Results

Conclusion