Predictors of primary care psychological therapy outcomes for treatment of depression and anxiety in people living with dementia: evidence from national healthcare records in England

Abstract

AbstractBackgroundPrimary care psychological therapy services can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD) and are recommended in national guidelines (e.g., NICE, UK). However, it is currently unknown which factors are associated with better psychological therapy outcomes in PLWD.MethodNational linked healthcare records (IAPT, HES, MHSD, HES‐ONS mortality data) were used to identify 1,522 PLWD who attended psychological therapy services across England. Associations between various factors (dementia‐specific and non‐dementia specific) and therapy outcomes on widely used anxiety (GAD7) and depression (PHQ9) measures (reliable improvement, recovery, deterioration, dropout) were explored.ResultPeople with FTD were more likely to experience a deterioration in depression or anxiety symptoms compared to people with vascular dementia (OR = 2.98, 95%CI[1.08,8.22], p = .03) and people with Alzheimer’s disease (OR = 2.95, 95%CI[1.15,7.55], p = .03). Age at dementia diagnosis did not predict any therapy outcomes after controlling for sociodemographic and clinical factors. Greater depression severity (recovery: OR = .95, 95%CI[.92,.98], p<.001; deterioration: OR = 1.73, 95%CI[1.04,2.90], p = .04), lower anxiety severity (improvement: OR = 1.06, 95%CI[1.03,1.09], p<.001; deterioration: OR = .89, 95%CI[.84,.94], p<.001; dropout: OR = 1.06, 95%CI[1.02,1.11], p = .01), lower work and social functioning (improvement: OR = .98, 95%CI[.96,.99], p = .002; recovery: OR = .98, 95%CI[.96.99], p = .002; dropout: OR = 1.03, 95%CI[1.01,1.05], p = .01), psychotropic medication use (improvement: OR = .62, 95%CI[.46,.84], p = .002; recovery: OR = .67, 95%CI[.51,.90], p = .01; deterioration: OR = 1.73, 95%CI[1.04,2.90], p = .04), being working age (improvement: OR = 2.11, 95%ci[1.10, 4.04], p = .02; recovery: OR = 2.03, 95%CI[1.10,3.73], p = .02), and fewer therapy sessions (improvement: OR = 1.10, 95%CI[1.06,1.14], p<.001; recovery: OR = 1.12, 95%CI[1.09,1.16], p<.001) were all associated with worse psychological therapy outcomes in PLWD.ConclusionPredictors of psychological therapy outcomes in PLWD were largely in line with those identified for a general population above and beyond dementia‐specific factors. Additional support and adaptations, such as more therapy sessions and regular clinical reviews, may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression.