Improving Access to Psychological Therapies (IAPT) services outcomes for people with learning disabilities: national data 2012–2013 to 2019–2020

Effectiveness of primary care psychological therapy services for treating depression and anxiety in autistic adults in England: a retrospective, matched, observational cohort study of national health-care records

BACKGROUND

Autistic adults report a higher prevalence of anxiety and depression than adults without identified autism but have poorer access to appropriate mental health care. Evidence-based psychological therapies are recommended in treatment guidelines for autistic adults, but no study has investigated their effectiveness in large samples representative of the autistic population accessing routine care. This study aimed to examine therapy outcomes for autistic adults in a primary care service.

METHODS

In this retrospective, matched, observational cohort study of national health-care records, we used the MODIFY dataset that used linked electronic health-care records, including national data, for individuals who accessed psychological therapy in primary care in Improving Access to Psychological Therapies (IAPT) services in 211 clinical commissioning group areas in England, UK. All adults aged 18 years or older who had completed a course of IAPT in 2012-19 were eligible, and were propensity score matched (1:1) with a comparison group without identified autism. Exact matching was used, when possible, for a range of sociodemographic factors. Primary outcomes were routine metrics that have been nationally defined and used to evaluate IAPT treatments: reliable improvement, reliable recovery, and reliable deterioration. Secondary outcomes were calculated pre-post treatment changes in scores for Patient Health Questionnaire-9, Generalised Anxiety Disorder Assessment-7, and Work and Social Adjustment Scale measures. Subgroup analyses investigated differential effects across a range of sociodemographic factors.

FINDINGS

Of 2 515 402 adults who completed at least two sessions of IAPT in 2012-19, 8761 had an autism diagnosis (5054 [57·7%] male and 3707 [42·3%] female) and 1 918 504 did not (631 606 [32·9%] male and 1 286 898 [67·0%] female). After propensity score matching, 8593 autistic individuals were matched with an individual in the comparison group. During IAPT treatment, symptoms of depression and generalised anxiety disorder decreased for most autistic adults, but symptoms were less likely to improve in the autism group than in the comparison group (4820 [56·1%] of 8593 autistic adults had reliable improvement vs 5304 [61·7%] of 8593 adults in the matched group; adjusted odds ratio [ORadj] 0·75, 95% CI 0·70-0·80; p<0·0001) and symptoms were more likely to deteriorate (792 [9·2%] vs 619 [7·2%]; ORadj 1·34, 1·18-1·48; p<0·0001). In the comparison group, improved outcomes were associated with employment and belonging to a higher socioeconomic deprivation category, but this was not the case for autistic adults.

INTERPRETATION

Evidence-based psychological therapy for depression or anxiety might be effective for autistic adults but less so than for adults without identified autism. Treatment moderators appear different for autistic individuals, so more research is needed to allow for better targeted and personalised care.

FUNDING

Alzheimer's Society.

Adaptation, Academic Performance and Support: Students with and without Disabilities and Future Considerations for Counselling Psychology

The transition to university is a process that presents young adults with several challenges in adaptation, especially students with disabilities. The current study investigated the differences in adaptation and academic performance between students with and without disabilities and further examined these differences among students with disabilities. Additionally, we explored the role of academic support for students with disabilities' adaptation and academic performance, as well as their perceptions of a proposed specialised package of counselling psychology interventions. The sample consisted of 127 students with disabilities and 127 without disabilities, aged 18-24 years. Results revealed that students with disabilities reported a lower GPA and adaptation than students without disabilities. Additionally, differences among students with disabilities were observed only in terms of GPA, according to their disability type, existence of comorbidity and type of exam accommodations. Interestingly, no differences were found in GPA or adaptation between students with disabilities who utilised psychological therapy and those who did not. Finally, adaptation scores, but not GPA, were higher for students with disabilities who were positive in receiving a specialised package of counselling psychology interventions. The findings are discussed in relation to the existing literature and future considerations of counselling psychology's role in support of students with disabilities.