Outcomes for treatment for anxiety and depression

The main facts and figures show that:

  • for each ethnic group, the majority of referrals through Improving Access to Psychological Therapies (IAPT) for a course of treatment or therapy showed an improvement on completion, rather than a deterioration or no change

  • IAPT referrals for White patients were more likely to have shown an improvement compared with other broad ethnic groups, and those for patients from the Asian or Other ethnic groups were the least likely to – this was found for both men and women

  • among the specific ethnic groups, the highest percentage of IAPT referrals that showed improvement were for patients who were White British, White Irish or who identified as ‘Other White’ (for both men and women)

  • IAPT referrals for patients in the Bangladeshi, Pakistani, Other Asian or Other ethnic groups were the least likely to have shown improvement (for both men and women)

  • women’s IAPT referrals were more likely to have shown improvement than men’s, with the exception of women of mixed White and Asian background and Bangladeshi women (for the latter, the rates of improvement were very similar to those of men)

  • new data has been published for the year 2016/17, and data for 2015/16 has been revised for the ‘no reliable change’ category – this data isn’t currently reflected in the charts, tables and commentary on this page, but the findings for 2015/16 presented here are broadly the same despite the revision, and you can get a CSV file with the latest figures if you download the data
Things you need to know

About 900,000 people get treatment each year through Improving Access to Psychological Therapies (IAPT) services. IAPT is an adult service, but contains a small amount of referrals for patients who are under 18.

The definition for ‘no reliable change’ has been revised since this page was published. Although the percentages shown here for ‘no reliable change’ are slightly larger (by about 3 percentage points) than found in the revised 2015/16 data for all ethnic groups, the findings are broadly the same. You can get a CSV file with the latest figures if you download the data. This revision does not affect the percentages presented here for ‘reliably improved’ or ‘reliably deteriorated’.

The revised methodology separates out patient referrals which showed no reliable change from those for whom it was not possible to assess change. These are referrals where data was not available to compare their first and last scores on the clinical assessments, as described in the Methodology section.

IAPT data is based on monthly submissions to NHS Digital by providers of these services and providers are required to record the ethnicity of patients. The proportion of IAPT patients with a recorded ethnicity has risen gradually, from about 80% in April 2015 to about 85% in March 2016. This analysis only includes referrals for which a valid ethnicity was recorded.

The data presented here is at the national level. The ‘download the data’ section contains data at the local level by clinical commissioning groups (CCGs). These are the NHS bodies that in 2013 replaced primary care trusts in their role of planning and commissioning health care services at the local level. In 2015/16 there were 209 CCGs and 2 commissioning hubs. In many CCG areas, however, the number of patients in some ethnic groups was too small to be reliable and has been suppressed.

What the data measures

This data measures outcomes for all referrals for treatment for anxiety or depression made through the NHS’s Improving Access to Psychological Therapies (IAPT) services. The data is broken down by ethnicity.

IAPT is a wide-ranging initiative providing evidence-based psychological therapies to people in England with anxiety disorders and depression. The outcomes for referrals are assessed as showing either:

  • improvement – where there is a significant improvement in the patient’s condition
  • no change – where there is no significant change in the patient’s condition (neither improvement nor deterioration)
  • deterioration – where there is significant deterioration in the patient’s condition

Outcomes are assessed using the responses patients made to questionnaires that were tailored to their health condition and measured their depression and anxiety over the course of their treatment. These give a clinically reliable basis for determining patients’ outcomes.

A referral must have ended in the financial year 2015/16 and the patient must have attended at least 2 appointments in the course of the referral.

The ethnic categories used in this data

The 16 categories used in this data are those listed in the 2001 Census. The categories are broadly the same as those used in the 2011 Census, with the following exceptions:

  • the 2001 Census categorised Chinese people within 'Other ethnic group'
  • the 2001 Census did not list Gypsy and Irish Travellers or Arab people

The 2001 categories are therefore as follows:

White:

  • English/Welsh/Scottish/Northern Irish/British
  • Irish
  • Any Other White background

Mixed/Multiple ethnic groups:

  • White and Black Caribbean
  • White and Black African
  • White and Asian
  • Any Other Mixed/Multiple ethnic background

Asian/Asian British:

  • Indian
  • Pakistani
  • Bangladeshi
  • Any Other Asian background

Black/African/Caribbean/Black British:

  • African
  • Caribbean
  • Any Other Black/ African/ Caribbean background

Other ethnic group:

  • Chinese
  • Any Other ethnic group

Ethnic groups and how data on ethnicity is collected

Outcomes of referrals following psychological therapy by ethnicity

Percentage of referrals showing improvement, deterioration or no change following a course of psychological therapy, by ethnicity

Ethnicity Reliably improved No Reliable Change Reliably deteriorated
% % %
Asian 56.7 34.9 8.4
Bangladeshi 53.9 35.4 10.7
Indian 59.2 33.5 7.4
Pakistani 54.9 36.0 9.1
Asian other 55.2 36.1 8.7
Black 59.8 32.1 8.2
Black African 58.8 32.7 8.5
Black Caribbean 60.8 31.5 7.7
Black other 58.6 32.7 8.7
Mixed 58.6 34.1 7.3
Mixed White/Asian 58.2 34.4 7.4
Mixed White/Black African 60.8 31.4 7.8
Mixed White/Black Caribbean 58.8 34.2 7.0
Mixed other 58.0 34.6 7.5
White 63.5 30.6 6.0
White British 63.6 30.5 5.9
White Irish 63.8 30.4 5.9
White other 61.9 31.4 6.8
Other 56.4 35.5 8.1
Other - Any Other 55.7 35.9 8.4
Other - Chinese 60.6 32.8 6.6

Download table data (CSV) Source data (CSV)

Summary

This data shows that for IAPT services in 2015/16:

  • referrals for White adults were more likely to show improvement following therapy (63.5%) than for other ethnic groups
  • the referrals least likely to show improvement were for the Asian (56.7%) and Other (56.4%) broad ethnic groups
  • for specific ethnic groups, referrals for the White British and the White Irish ethnic groups were the most likely to show improvement (63.6% and 63.8% respectively) and also the least likely to show deterioration (5.9% in both groups) or no change (slightly over 30% each)
  • the Asian ethnic groups for whom referrals were least likely to show improvement were Bangladeshi (53.9%), Pakistani (54.9%) and Other Asian (55.2%), compared with referrals for Indian patients (59.2%)
  • 10.7% of referrals for Bangladeshi patients showed deterioration – the highest percentage for any ethnic group
  • referrals for patients from the Other Asian or Pakistani specific ethnic groups were the most likely to show no change (around 36% for both groups)

Outcomes of referrals following psychological therapy by ethnicity and gender

Percentage of referrals showing improvement, deterioration or no change following a course of psychological therapy, by ethnicity and gender

Reliably improved No Reliable Change Reliably deteriorated
Ethnicity Men (%) Women (%) Men (%) Women (%) Men (%) Women (%)
Asian 54.7 57.8 36.5 34.0 8.8 8.2
Bangladeshi 54.1 53.9 35.1 35.4 10.8 10.7
Indian 57.3 60.1 35.7 32.3 7.0 7.6
Pakistani 52.3 56.5 37.2 35.2 10.5 8.3
Asian other 53.6 56.4 37.3 35.3 9.1 8.4
Black 57.1 60.9 34.9 30.8 8.0 8.2
Black African 55.7 60.2 35.8 31.2 8.4 8.6
Black Caribbean 59.0 61.5 33.3 30.7 7.7 7.8
Black other 54.5 60.5 37.4 30.5 8.1 9.0
Mixed 57.0 59.3 36.3 33.1 6.7 7.6
Mixed White/Asian 59.4 57.7 34.3 34.3 6.3 7.9
Mixed White/Black African 58.9 61.6 35.0 29.8 6.1 8.6
Mixed White/Black Caribbean 55.7 60.1 37.6 32.8 6.6 7.1
Mixed other 56.6 58.6 36.3 33.8 7.2 7.6
White 62.5 64.1 31.7 29.9 5.9 6.0
White British 62.6 64.1 31.6 29.9 5.8 5.9
White Irish 61.9 65.0 32.6 28.9 5.5 6.1
White other 60.0 62.7 33.2 30.6 6.9 6.7
Other 53.3 58.0 38.7 33.9 8.1 8.1
Other - Any Other 52.9 57.2 38.9 34.4 8.2 8.4
Other - Chinese 55.8 62.3 37.0 31.3 7.2 6.4

Download table data (CSV) Source data (CSV)

Summary

This data shows that for IAPT services in 2015/16:

  • for referrals for women, the White ethnic group had the highest rate of improvement amongst the broad ethnic groups, at 64.1%, while the Asian and Other ethnic groups had the lowest rates of improvement, at 57.8% and 58.0% respectively
  • for referrals for men, the White ethnic group had the highest rate of improvement amongst the broad ethnic groups, at 62.5%, while the Asian and Other ethnic groups had the lowest rates of improvement, at 54.7% and 53.3% respectively
  • women’s referrals were more likely to show improvement than men’s in each ethnic group, with the exception of the mixed White and Asian group (59.4% of men’s referrals compared to 57.7% of women’s) and the Bangladeshi group (54.1% of men’s, 53.9% of women’s)
  • for both women’s and men's referrals, the specific ethnic groups most likely to show improvement were White Irish (65% of women’s, 61.9% of men’s) and White British (64.1% of women’s, 62.6% of men’s)
  • for men’s referrals, the specific ethnic groups most likely to show deterioration were Bangladeshi (10.8%) and Pakistani (10.5%)
  • for women’s referrals, the specific ethnic groups most likely to show deterioration were Bangladeshi (10.7%) and Other Black (9.0%)

Methodology

Methodology

Data is submitted by providers of Improving Access to Psychological Therapies (IAPT) services on a monthly basis. This means that information about referrals is updated each month. Providers have 2 opportunities to submit a month's data, known as primary and refresh windows. Published data will always be based on a refresh submission unless it was not provided, in which case the primary submission is used.

Ethnic group is a required field in the IAPT dataset. This means that wherever providers hold or collect this information about a person, it should be included in their submission to NHS Digital.

For all referrals, a Patient Health Questionnaire (PHQ-9) is used, alongside either a Generalised Anxiety Disorder (GAD7) questionnaire or an Anxiety Disorder Specific Measure (ADSM), depending on the recorded diagnosis. ADSMs are questionnaires that are sensitive measures of the severity of particular anxiety disorders. The IAPT Data Handbook recommends relevant ADSMs for:

  • obsessive-compulsive disorder
  • generalised anxiety disorder
  • social phobia
  • health anxiety
  • agoraphobia
  • panic disorder
  • post-traumatic stress disorder

If one of these conditions is recorded, the relevant ADSM should be used to measure change in anxiety during treatment. If the relevant ADSM has not been given at least twice during a course of treatment, or if the condition recorded is not one of those specified in the above list, the GAD7 (IAPT’s generic anxiety measure) is used to assess change in anxiety.

The patient’s first and last scores are compared for both the PHQ-9 and the relevant anxiety questionnaire. A referral has shown reliable improvement if there is a reliable decrease on one or both of the scores on these questionnaires, and no reliable increase in either of them.

A reliable change is defined as either a PHQ-9 change of 6 points or more, or one of the following, depending on which questionnaire is asked:

  • GAD7 - a change of 4 points or more
  • Agoraphobia Mobility Inventory - a change of 0.73 or more
  • Social Phobia Inventory - a change of 10 points or more
  • Panic Disorder Severity Scale does not have an agreed threshold so GAD7 is used
  • Obsessive Compulsive Inventory - a change of 32 points or more
  • Impact of Events Scale - a change of 9 points or more
  • Health Anxiety Inventory (Short Week) - a change of 4 points or more

Rounding

Figures have been rounded to 1 decimal point.

Related publications

Adult improving access to psychological therapies programme

Quality and methodology information

Further technical information

For more information, see Appendix 3 of the 2015-16 IAPT annual publication.

Data sources

Source

Type of data

Administrative data

Type of statistic

Official statistics

Publisher

NHS Digital

Publication frequency

Yearly

Purpose of data source

The data is used to to monitor and improve the provision of talking therapies services for the treatment of people with anxiety and/or depression.

Download the data

Outcomes for treatment for anxiety and depression - Spreadsheet (csv) 7 MB

This file contains data for 2015/16 (not revised). This is the data used in the charts, tables and commentary shown on this page. This file contains the following: ethnicity, geography, gender, outcome, value, denominator, numerator

Outcomes for treatment for anxiety and depression v2 - Spreadsheet (csv) 16 MB

This file contains data for 2015/16 (revised) and 2016/17. This is the latest data available, but does not reflect the figures shown in the charts, tables and commentary on this page. This file contains the following: ethnicity, geography, gender, outcome, value, denominator, numerator