Outcomes from a pilot psychological therapies service for UK military veterans.
Paul Clarkson, Clarissa M Giebel, David Challis and 3 others
PMID 27708834WHAT IT FOUND
Veterans receiving a tailored psychological therapies service improved on depression and anxiety scores, especially those who completed treatment.
Among completers, 57% recovered from depression and 54% from anxiety. No control group means this cannot prove the service caused change.
Key findings
01For the 505 veterans analysed, depression, anxiety and social adjustment scores improved significantly from assessment to last available session.
02For depression, recovery was 57% among those who completed treatment, 17% among those remaining in treatment and 17% among those who dropped out; for anxiety, the rates were 54%, 16% and 11% respectively.
03Patients with a forensic history or substance misuse were more likely to drop out before treatment completion.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study had no control group, so improvement over time cannot be separated from natural recovery or other changes in patients' circumstances. Patients were not randomly assigned to the service, and those who completed, remained in treatment or dropped out differed in forensic history, substance misuse and missed sessions. Only patients with at least two sessions were analysed, so people who attended only an assessment were not included in outcome comparisons. Baseline scores were in the high range, so regression to the mean could contribute to apparent improvement. Several therapies were delivered together by different professionals, so the effect of any single treatment or professional group cannot be isolated. The service was evaluated in one UK pilot over 20 months, so it may not apply to other veterans, services or countries.
Declared interests
The evaluation was funded by a grant from Pennine Care NHS Foundation Trust to PSSRU, University of Manchester. Some authors were employed by Pennine Care, and some worked in the veterans IAPT service being evaluated. Other declared authors reported no conflicts.
The easy way to misread this
Do not conclude that the psychological therapies service caused these improvements. The study had no control group, patients were not randomly assigned, and many different therapies were delivered together, so natural recovery, selection and other factors cannot be ruled out.