Personality difficulties and response to community-based psychological treatment for anxiety and depression
Mars, B; Gibson, J; Dunn, BD; et al.Gordon, C; Heron, J; Kessler, D; Wiles, N; Moran, P
Date: 26 September 2020
Journal
Journal of Affective Disorders
Publisher
Elsevier
Publisher DOI
Abstract
Background: Previous research suggests that comorbid personality disorder may be associated with
a less favourable treatment outcome for individuals with depression and anxiety disorder. However,
little is known about whether personality difficulties are associated with treatment outcomes within
Improving Access to Psychological ...
Background: Previous research suggests that comorbid personality disorder may be associated with
a less favourable treatment outcome for individuals with depression and anxiety disorder. However,
little is known about whether personality difficulties are associated with treatment outcomes within
Improving Access to Psychological Therapies (IAPT) services-the largest platform for treating
depression and anxiety in England, UK. Secondary aims were to investigate i) whether individual
personality difficulties are associated with treatment outcome and ii) whether findings are
moderated by treatment type.
Methods: The sample included 3,689 adults who accessed community-based psychological
treatment (cognitive behavioural therapy, emotional skills training, or other psychological therapy)
for depression and/or anxiety disorder. Associations between personality difficulties (assessed with
the Standardised Assessment of Personality–Abbreviated Scale (SAPAS)) and treatment outcomes
(recovery and reliable improvement in depression/anxiety symptom scores, assessed using
questionnaire-based measures) were investigated using logistic/linear regression.
Results: Personality difficulties were associated with a reduced likelihood of recovery (adjusted OR
per unit increase on SAPAS: depression=0.87, 95%CI 0.84, 0.91; anxiety=0.86, 95%CI 0.82, 0.90) and
reliable improvement (adjusted OR per unit increase on SAPAS: depression=0.88, 95%CI 0.84, 0.92;
anxiety=0.85, 95%CI 0.82, 0.89).. Those with three or more difficulties were over 30% less likely to
recover/reliably improve.
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Limitations: Personality difficulties data were collected via self-report and were not available for all
participants.
Conclusion: Patients with personality difficulties have a less favourable response to psychological
treatment for depression/anxiety disorder. If replicated, the findings highlight a major challenge to
the way community-based psychological therapy services in England (IAPT services) are presently
constituted.
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