Exploring social factors in the psychological treatment of anxiety and mood disorders

焦虑和抑郁是非常普遍的和令人衰弱的疾病，会带来巨大的经济和社会代价。为了解决大量未接受治疗的人与这些疾病作斗争，英国于2008年启动了改善获得心理治疗(IAPT)的倡议。IAPT为初级保健环境中的焦虑和抑郁患者提供循证心理治疗。然而，对这些治疗的反应有很大的差异，大约50%的患者在治疗后症状水平没有明显改善。人们对这些个体差异的根源知之甚少，对社会功能变化的结果更是知之甚少。目前的证据表明，需要围绕风险变量进行量身定制的治疗，以促进IAPT服务的长期结果和成本效益的改善。到目前为止，大多数探索心理治疗反应预测因素的研究只集中在临床试验上。童年创伤已被发现是心理障碍发展和持续的关键风险因素，临床试验表明与心理治疗结果有关。最近，有研究表明，儿童创伤与IAPT治疗后复发风险之间存在关联。这些关联可能反映了对社会状况的负面偏见。在探索心理治疗结果的预测因素时，遗传因素也被发现提供了重要信息。本研究的目的是探索与IAPT心理治疗结果相关的社会和遗传风险变量。具体地说，它将(I)探讨儿童创伤等社会风险因素是否可以预测治疗反应；(Ii)扩大治疗反应的评估范围，以包括社会功能的衡量；(Iii)调查与儿童创伤病史和心理治疗反应之间的关系有关的心理社会因素；以及(Iv)将遗传和社会风险因素纳入IAPT治疗反应的总体预测。这将加强与参与者的沟通，并在治疗前、治疗后和后续行动中在线收集数据，包括人口和社会信息。与NIHR资助的精神病学、心理学和神经科学研究所的生物资源合作，将能够探索焦虑、抑郁和对心理治疗反应差的风险的全基因组多基因风险得分。通过这项研究，将探索使用社会和遗传风险因素作为预测IAPT患者预后最有利的治疗因素的可能性。

Anxiety and depression are highly prevalent and debilitating disorders, with huge economic and social costs. To address the large number of untreated individuals struggling with these disorders, the UK Improving Access to Psychological Therapy (IAPT) initiative was started in 2008. IAPT provides evidence-based psychological therapies for patients with anxiety and depression in a primary care setting. However, substantial variation in responses to these treatments is evident, with roughly 50% of patients not showing significant improvements in symptom levels following treatment. Little is known about the source of these individual differences, and even less is understood about outcomes in terms of changes in social functioning. Evidence currently suggests a need to tailor treatments around risk variables, in order to promote improvements in long-term outcomes and cost-effectiveness of the IAPT service.To date, the majority of research exploring predictors of psychological treatment response has only focused on clinical trials. Childhood trauma has been found to be a key risk factor in the development and persistence of psychological disorders, and in clinical trials has been shown to relate to psychological treatment outcomes. More recently, associations have been shown between childhood trauma and risk of relapse following treatment in IAPT. These associations may reflect negative biases regarding social situations. Genetic factors have also been found to provide important information when exploring predictors of psychological therapy outcomes. The aim of this research is to explore the social and genetic risk variables relevant to the outcomes of psychological treatments in IAPT. Specifically, it will (i) address whether social risk factors such as childhood trauma predict treatment response; (ii) extend the assessment of treatment response to include measures of social functioning; (iii) investigate psychosocial factors associated with the relationship between a history of childhood trauma and psychological treatment response; and (iv) incorporate genetic and social risk factors in the overall prediction of treatment response in IAPT.This project will involve large-scale prospective recruitment of IAPT service users using an online recruitment platform. This will enable greater communication with participants as well as online data collection at pre-treatment, post-treatment and follow-up, including demographic and social information. Collaborating with the NIHR-funded BioResource at the Institute of Psychiatry, Psychology and Neuroscience will enable the exploration of genome-wide polygenetic risk scores for anxiety, depression and risk of poor response to psychological treatment. Through this research, the potential to use social and genetic risk factors as predictors of the treatments that will be most beneficial to patients' outcomes in IAPT will be explored.