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Dissertation

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Katie Waters

on 16 January 2013

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Transcript of Dissertation

Rationale Introduction
Treats common mental health problems - anxiety and depression

Anxiety and depression effects 9% of UK population (Rogers, 2013) or 6.1 million (IAPT, 2012)

Common side affect - inability to work (Virtanen, 2008)

Incapacity benefits and sick pay costs government billions annually An investigation into the relationship between depression and anxiety and work and social functioning within the context of IAPT Method Participants Analysis Discussion Katie Waters Dissertation presentation Hypothesis Design Procedure Materials Results Aims Clinical implications Based on placement - context of IAPT - Increasing Access to Psychological Therapy Lord Richard Layard proposed IAPT to save money (2005) spent on incapacity benefits and sick pay

IAPT uses short course of CBT (12-18 sessions)

Measures improvement of symptoms using self report questionnaires

GAD-7, PHQ-9 and WSAS If a strong relationship between improved anxiety and depression scores and improved WSAS scores is found - may indicate IAPT fulfilling original purpose – helping people get back into work.

If not the case why is this?

Implications on whether government should continue funding it? To explore the predictive relationship of change in PHQ and change in GAD scores on the change in WSAS scores.

i.e. does an improvement in PHQ and GAD predict an improvement in WSAS. I predict there will be a strong predictive relationship between improvement in PHQ (depression) and GAD (anxiety) scores on WSAS score. Clinicians under pressure to produce positive recovery rates.

Job and funding cuts = crucial to examine effectiveness of IAPT.

If strong predictive relationship is NOT found = implications on the type of therapy used to treat anxiety and depression?

CBT accused of being, 'flavour of the month' (Newnes, 2011).

A, 'quick fix' (Jackson, 2006).

A, 'one size fits all approach' (Johansson, 2012).

CBT may/may not be appropriate choice of therapy. Selected from IAPT patient database PCMIS – Patient Care Management Information System.

Unique reference number for each participant/patient - data stored anonymously and ethically. PHQ-9 questionnaire GAD-7 questionnaire WSAS questionnaire PCMIS
Excel
SPSS Self-report scale.
Frequency of symptoms in past 2 weeks.
Scores 1-4 sub-clinical depression, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe. Example questions Quasi experimental design (participants not randomly assigned to different groups)

IV’s
1. Change in PHQ9 score
2. Change in GAD7 score

DV change in WSAS score

Advantages and disadvantages of this design? Reliability and validity Ethics Model accounts for 35% of variation in scores.
Positive linear relationship. As PHQ and GAD scores improve so do WSAS scores.
Depression contributes slightly more to predicting WSAS score Self-report questionnaire
Frequency of symptoms in past 2 weeks.
Scores 0-4 sub-clinical, 5-9 mild, 10-14 moderate, 15-21 severe anxiety. Example questions Example question Self-report scale.
Five areas – work, home, social, private leisure, family relationships.
Scores combined.
0-10 sub-clinical, 10-20 significant impairment.
20 and above moderate to severe psychopathology. Easily replicable (William, 2002)
Widely used clinical measures
Quasi-experimental design = high ecological and external validity (Martella, 1999)
Internal validity - questionable
Hard to control for extraneous variables (Brewer, 2000) Anonymous patient reference numbers
Patients consent
Ethical approval was achieved from Bath University ethics committee PCMIS ‘data-run.’

Excel created two IV's (change in PHQ, change in GAD) and DV (change in WSAS) subtracting final scores from original scores.

Data into SPSS.

Assumptions of standard multiple regression explored.

Ran analysis. Participants/patient completed short course (12-18 sessions) high-intensity CBT between April 2011-April 2012.

Aged 18-65
Demographics:

Sample size: 721

Gender: 472 female, 236 male, 13 did not disclose

Age: average 39 years, S.D. 12.9, Min. 18, Max

All lived in London Borough of Camden. Standard multiple regression:

Continuous not categorical data.
Interaction/relationship between variables.
Predictive power.
Strength of relationship.
Most widely and commonly used (Tabachnick and Fidell, 2007). Assumptions:

Sample size/ratio of cases to IV’s
Multicollinearity and singularity
Outliers
Normality
Homoscedasticty
Independence of errors 1. Model accounts for 35% variation in population.
2. Positive linear relationship. PHQ and GAD scores improve so does WSAS scores.
3. Depression contributes slightly more to prediction of WSAS.

Therefore:

Layard was right re IAPT
IAPT effectiveness?
Government continue investing if only 35% of variation is accounted for?

Research shows is effective:

IAPT report (July 01 - Sept 30, 2012) recovery rates 46%.
6309 people came off sick pay and benefits - got back to work. Reasons for results:

1. CBT appropriate intervention?
2. Questionnaires unreliable?
3. Extraneous variables?
CBT – ‘flavour of the month,’ ‘One size fits all,’ ‘quick fix.’

12-18 sessions not enough?

Does not deal with causes of symptoms?

Taught set of standardised cognitive techniques to cope with symptoms.

High rates of re-referral.

More holistic approach needed?

More long term support needed?

Requires funding.

But worthwhile investment.
• Reliability of questionnaires used to evaluate improvement?

• Self-report - may over/under report symptoms - inaccurate data.

• Clinical samples missing data - inaccurate measure of reality?

• Patients leave questions out, do not want to answer them, clinicians forget give questionnaire out.

• Questionnaires not extensive enough – only 9/7 questions – enough to assess complex problem? Extraneous variables:


Area participants live in – environment can exacerbate symptoms and ability to work.

Team meetings belief that north of Camden, experience more severe symptoms than those living in the south.

Little research to support this however clinicians seemed to firmly believe differences in recovery rates due to more severe patients in north than south. What about third finding – depression contributed marginally to predicting WSAS?

Implies depression effects ability to work more than anxiety.

Area for future research. Research question?

Moderate positive linear relationship between change in depression and anxiety score and change in work and social functioning score.

Hypothesis correct.

IAPT pretty good at treating anxiety and depression and helping people get back to work.

CBT effective intervention?

Appears to be, however room for improvement.

Government continue investing in IAPT?

Yes – results show an effective intervention.

Anxiety and depression affects us all, both sexes, all ages, all professions, all walks of life. References F(2,718)=192.457, p< .001
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