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. 2025 May 19;28(1):e301632.
doi: 10.1136/bmjment-2025-301632.

Physical long-term conditions and the effectiveness of England's NHS Talking Therapies programme for working-age adults: findings from a South London borough

Amy Ronaldson  1 , Matthew Broadbent  2 , Brendon Stubbs  3   4 , Lisa Harber-Aschan  5 , Nicusor Sima  6 , David Armstrong  7 , Ioannis Bakolis  8 , Stephani Hatch  3 , Matthew Hotopf  3   9 , Alex Dregan  10
Affiliations

Physical long-term conditions and the effectiveness of England's NHS Talking Therapies programme for working-age adults: findings from a South London borough

Amy Ronaldson et al. BMJ Ment Health. .

Abstract

Objective: To assess the effectiveness of NHS Talking Therapies (NHSTT) service for working-age adults with mild to moderate depression or anxiety and to evaluate the impact of multiple physical long-term conditions (LTCs) on treatment outcomes.

Method: We have linked routinely collected data from the NHSTT services in South London (UK) with primary care data for aged 18-64 years who had accessed the services between August 2008 and March 2021. The main outcome measures were NHSTT service key performance indicators of 'recovery' and 'reliable improvement'. Multiple and specific physical LTCs represented the exposure of interest. Cox proportional hazard models were used to assess associations between physical LTC exposures and outcomes.

Findings: Among 35 814 adults (mean age=37, 67% women) attending the NHSTT, physical LTCs were associated with moderately lower 'recovery' rate (adjusted HR (aHR)=0.91, 95% CI 0.88 to 0.95) relative to no LTCs. A dose-response relationship was also observed: the likelihood of 'recovery' decreased with the number of physical LTCs (one condition: aHR=0.95, 95% CI 0.91 to 0.98; two conditions: aHR=0.88, 95% CI 0.83 to 0.93; three conditions: aHR=0.82, 95% CI 0.75 to 0.91; four or more conditions: aHR=0.72, 95% CI 0.61 to 0.85).

Conclusion: Among working-age adults, the effectiveness of NHSTT services varied with the number and type of physical LTCs. These findings highlight the need for tailored interventions for patients with multiple physical LTCs to improve treatment outcomes.

Keywords: Adult psychiatry; Anxiety disorders; Depression; Depression & mood disorders.

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Conflict of interest statement

Competing interests: AR, MB, BS, DA, IB, MH and AD have nothing to disclose. SH is a member of the following: Expert Review Group (ERG) of the UK Prevention Research Partnership (UKPRP) Ethnic inequalities in health care among people with multiple conditions (University of Sussex) – Advisory Board NHS Race and Health Observatory, Co-Chair Academic Reference Group and Board Member The Royal Foundation—Mental Health Research Group NHS England and NHS Improvement—The Mental Health Equalities Data Quality and Research Subgroup NHS England and NHS Improvement—Patient and Carers Race Equalities Framework [PCREF] Steering Group NHS England and NHS Improvement—Advancing Mental Health Equalities Taskforce Health Education England—Mental Health Workforce Equalities Subgroup Maudsley Learning—Maudsley Learning Advisory Board South London and Maudsley NHS Foundation Trust (SLaM)—Independent Advisory Groups, the SLaM Partnership Group Lambeth Public Health—Serious Youth Violence Public Health Task and Finish Group Thrive London—Thrive London Advisory Board Black Thrive—Black Thrive Advisory Board NHS England and NHS Improvement—The Mental Health Workforce Equalities Subgroup Commissions: Welsh Government’s Race Equality Plan; contribution to the evidence review for Health and Social Care and Employment and Income policy areas.

Figures

Figure 1
Figure 1. Forest plot showing the adjusted association between number of long-term conditions and NHSTT treatment outcomes. The analyses adjusted for all study covariates (age, gender, ethnicity, employment status, index of multiple deprivation, baseline symptom severity). NHSTT, NHS Talking Therapies.
See this image and copyright information in PMC

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