Prognosis-matched care may reduce psychological distress related to anxiety, depression

Matching interventions based on prognosis reduced psychological distress among individuals with anxiety or depressive symptoms, according to results of a pragmatic stratified randomized controlled trial published in The Lancet Psychiatry.

“We developed Link-me, a stepped-care approach that is digitally supported and prognostic, which aims to stratify people with anxiety or depressive symptoms in primary care to match treatment to their needs,” Susan Fletcher, PhD, of the department of general practice at the University of Melbourne in Australia, and colleagues wrote. “Link-me comprises two interrelated components. The first component is a brief patient-completed Decision Support Tool (DST) that draws on an individual’s responses to 23 items (assessing psychosocial factors — namely, gender, mental health history and current symptoms, general health, living situation, financial security) to predict their anxiety and depressive symptom trajectory over the next 3 months and stratify them into one of three prognostic groups (minimal/mild, moderate or severe). The second component is a recommendation for treatment pathways (low-intensity or high-intensity care), which depend on the predicted symptom severity.”

The researchers sought to determine whether Link-me could reduce psychological distress among individuals predicted to have minimal/mild or severe anxiety or depression symptoms. They analyzed data from 23 general practices in Australia of 1,671 individuals aged 18 to 75 years who reported depressive or anxiety symptoms or mental health medication use. Further, they classified participants into either minimal/mild, moderate or severe prognostic groups based on DST results and included those in the minimal/mild and severe groups. A total of 834 individuals were individually and randomly assigned to prognosis-matched care and 837 to usual care plus attention control, with assignment done by a computer-generated allocation sequence. Difference in the change in scores between the intervention and control group, and within prognostic groups, on the 10-item Kessler Psychological Distress Scale at 6 months post randomization, served as the primary outcome.

Results showed an association between prognosis-matched care and greater reductions in psychological distress vs. usual care plus attention control at 6 months, with a standardized mean difference (SMD) of –0.09 (95% CI –0.17 to –0.01). The researchers also observed this reduction among the severe prognostic group, with a SMD of –0.26 (–0.43 to –0.09); however, they did not observe it among the minimal/mild group, with a SMD of 0.04 (–0.17 to 0.24). Those who received some or all aspects of the intervention in the severe prognostic group had larger differences, per the complier average causal effect analysis. Fletcher and colleagues recorded no serious adverse effects.

“The findings of our trial support further pursuit of options to enhance Link-me, such as how it can be best integrated with existing health-care systems (taking into account the availability and accessibility of services across all levels of care, existing referral pathways, and payment mechanisms to service providers for Link-me-related care),” the researchers wrote. “With such enhancements, implementation of Link-me into routine practice could improve mental health outcomes while reducing unnecessary treatment burden and improving allocation of treatment resources.”