Personality difficulties and response to community-based psychological treatment for anxiety and depression

Becky Mars; Jo Gibson; Barnaby D Dunn; Christopher Gordon; Jon Heron; David Kessler; Nicola Wiles; Paul Moran

doi:10.1016/j.jad.2020.09.115

Personality difficulties and response to community-based psychological treatment for anxiety and depression

J Affect Disord. 2021 Jan 15:279:266-273. doi: 10.1016/j.jad.2020.09.115. Epub 2020 Sep 30.

Authors

Becky Mars¹, Jo Gibson², Barnaby D Dunn³, Christopher Gordon², Jon Heron⁴, David Kessler⁵, Nicola Wiles⁵, Paul Moran⁵

Affiliations

¹ Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, University of Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK. Electronic address: becky.mars@bristol.ac.uk.
² Mental Health & Learning Disabilities Directorate, Somerset Partnership NHS Foundation Trust.
³ Department of Psychology, University of Exeter.
⁴ Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, University of Bristol, UK.
⁵ Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, University of Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.

PMID: 33074146
DOI: 10.1016/j.jad.2020.09.115

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 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.

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.

Keywords: Depression; Personality difficulties; Psychological therapies; anxiety.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anxiety
Anxiety Disorders* / therapy
Depression*
England
Humans
Personality
Personality Disorders / therapy
Treatment Outcome