1. Couple therapy for depression –effectiveness monitoring

2. Main questions:
Do we see improvement in client scores on depression and anxiety?
Do we see improvement in clients’ relationship satisfaction?
Is improvement in relationship important for recovery from depression and anxiety?

3. Data
53 therapists were asked to provide the data about their clients’ scores on measures of depression, anxiety and couple satisfaction at intake, session 4 and end of therapy
N=37 therapists provided usable data (i.e., data including at least intake and the end-therapy scores).
In total the sample used for the analysis included the data from n=218 clients.
Average number of sessions: (max=25, /min=3)

4. Patient Health Questionnaire (PHQ9)
Scoring:
5-9 some mild depression;
10-14 moderate depression;
15-19 moderately severe;
20-27 severe
Caseness: 10 or above

5. Total sample
The blue line represents the “cut-off” point for caseness. The clients were, on average, within the clinical range at intake, and moved below the clinical range at session 4; depression scores continued to decrease while therapy continued; the scores at the end of therapy were significantly lower compared to scores at session 4 and the intake.

6. This graph shows the improvement in depression (decreasing scores on PHQ9) for the index client (in blue) and the partner (in red). There is much bigger improvement in depression scores for index clients – due to their higher intake scores. The blue line represents the “cut-off” point for caseness.

7. Generalized Anxiety Disorder (GAD7)
Scoring:
0-4 normal;
5-9 mild anxiety;
10-14 moderate;
15-21 severe
-IAPT-high Intensity uses score 8 and above as an indication of caseness
The

8. Total sample
The blue line represents the “cut-off” point for caseness. The clients were, on average, within the clinical range at intake, and moved below the clinical range at session 4; anxiety scores continued to decrease while therapy continued; the scores at the end of therapy were significantly lower compared to scores at session 4 and the intake.

9. This graph shows the improvement in anxiety (decreasing scores on GAD7) for the index client (in blue) and the partner (in red). There is much bigger improvement in anxiety scores for index clients – due to their higher intake scores. The blue line represents the “cut-off” point for caseness.

10. Couples Satisfaction Index (CSI-32)
Min-0 / Max-180; Higher scores denote higher relationship satisfaction
Distressed relationships cutoff: below 104.5

11. Total sample
The blue line represents the “cut-off” point for couples in distress. The clients were, on average within the “distressed” range at intake, and moved towards more couple satisfaction at the end of therapy.

12. Recovery rate Depression:
At intake 61.4% of clients had depression scores within the clinical range; out of those (n=127) who were in the clinical range at intake, 73.2% recovered at the end of therapy.
Anxiety:
At intake 62.3% of clients had anxiety scores within the clinical range; out of those (n=137) who were in the clinical range at intake, 75.1% recovered at the end of therapy.
Depression & Anxiety (IAPT criterion):
Out of n=201 clients who had data at intake and end of therapy for both measures n=96 (47.76%) reported recovery for both – depression and anxiety.
The recovery rate for depression was 73.2% and for anxiety 75.1%. Using the IAPT recovery criterion (recovery from both – anxiety and depression) we have 47.76% of recovery rate. By comparison other modes of therapy offered in IAPT have recovery rates at the level 47.8%(see on page 8:

13. Does improvement in relationship satisfaction predict recovery?
Yes, those whose relationship has improved (i.e. scores moved from the “distressed relationship” range to the “normal” range), were 3 times more likely to show recovery at the end of therapy. This result was true when we controlled statistically for the effect of depression and anxiety levels at intake (i.e. casness at intake).

14. Conclusions
There is evidence for statistically significant improvement in clients depression, anxiety and relationship satisfaction
There is evidence that the improvement in relationship satisfaction predicted recovery