Everyday evidence – therapy outcomes in Swedish public health service settings SPR 42nd annual meeting Bern, June 31, 2011 Andrzej Werbart & Lars Levin

Background Dodo bird & Equivalence paradox Empirically supported treatment (EST) Randomized controlled trials (RCT) Pros & cons Evidence based practice in psychotherapy (EBPP) QAPS

Research questions To investigate which patients get which treatment – comparing pre-treatment characteristics Total sample and by therapy type To compare outcomes from different forms of psychotherapy (CBT, PDT, INT) Replication of prior studies (CORE) To investigate whether different measures capture different aspects of change

Method Data collection Participants 13 outpatient services 1,500 pre-therapy questionnaires Attrition Procedure Self-ratings: SCL-90, QOLI (SRH, HAQ, CSQ) Therapist assessments Treatment methods: CBT, PDT, INT Statistical analysis Cohens d, RCSI

Attrition All patients where data at t1 is available N=1,498 DO from data collection n=535 (35.71%) Non-starters n=204 (13.62%) DO from treatment n=260 (17.36%) Completed therapies n=188 (12.55%) Ongoing therapies n=311 (20.76%) Core group n=180 Complete data t1 SCL-90: n=177 QOLI: n=178 Complete data t2 SCL-90: n=175 QOLI: n=176 Other or unspecified therapy type n=8 Treatment starters n=1,294 (86.38%) Remaining n=499 (33.31%)

Analysis of attrition Differences DO from treatment slightly younger DO from data collection more men slightly fewer previous psychiatric contacts Self-ratings – no significant differences Large groups All patients where data at t1 is available N=1,498 DO from data collection n=535 (35.71%) Non-starters n=204 (13.62%) DO from treatment n=260 (17.36%) Completed therapies n=188 (12.55%) Ongoing therapies n=311 (20.76%) Core group n=180 Complete data t1 SCL-90: n=177 QOLI: n=178 Complete data t2 SCL-90: n=175 QOLI: n=176 Other or unspecified therapy type n=8 Treatment starters n=1,294 (86.38%) Remaining n=499 (33.31%)

Three groups (n=350) CBT 63, PDT 206, INT 59 (22 other) No significant differences regarding: Gender (ca 70% female) Self-rating Significant differences: Age (INT younger, M=24.7 yrs vs 32.2 & 32.3) Level of education (INT less educated) Occupation Previous psychiatric contacts (CBT more) Characteristics - by therapy type

Self-rating - by therapy type

Results - core group, effectiveness All patients where data at t1 is available N=1,498 DO from data collection n=535 (35.71%) Non-starters n=204 (13.62%) DO from treatment n=260 (17.36%) Completed therapies n=188 (12.55%) Ongoing therapies n=311 (20.76%) Core group n=180 Complete data t1 SCL-90: n=177 QOLI: n=178 Complete data t2 SCL-90: n=175 QOLI: n=176 Other or unspecified therapy type n=8 Treatment starters n=1,294 (86.38%) Remaining n=499 (33.31%)

Results, core group - Effect size by therapy type

Results, core group - RCSI & RC by therapy type (GSI)

Results, core group - RCSI & RC by therapy type (QOLI)

Discussion Psychotherapy in public health services is effective for patients who complete treatment Cohens d 0.81 (GSI), 0.78 (QOLI) Clinical improvement larger when measured by GSI (54.8%) compared to QOLI (21.3%) Differences toward UK studies (CORE) Cohens d 1.39, RCSI=58.3% Different patients (primary care vs outpatient psychiatric services)

Discussion The different therapy methods did not differ significantly in effectiveness But effective for different aspects? Symptom (SCL-90) vs Quality of Life (QOLI) Systematic distribution of patients to treatments or therapists? Dose-effect: longer treatment necessary for changes in quality of life? Effects after termination?

Further research Dropouts Non-starters Non-responders Welcome to the poster session tonight!

Questions or comments? Andrzej Werbart Lars Levin