1
SilverCloud Research, SilverCloud Health, Dublin,
Ireland
2
E-mental Health Research Group, School of
Psychology, Trinity College Dublin, Dublin, Ireland
3
Berkshire Healthcare NHS Foundation Trust,
Bracknell, UK
Correspondence
Jorge Palacios, School of Psychology, Aras an
Phiarsaigh, Trinity College Dublin, Dublin, Ireland.
Email: jorge.palacios@tcd.ie
Funding information
SilverCloud Health; Berkshire Healthcare
Foundation Trust
Abstract
Low-intensity interventions for common mental disorders
(CMD) address issues such as clinician shortages and barriers
to accessing care. However, there is a lack of research into
their comparative effectiveness in routine care. We aimed to
compare treatment effects of three such interventions, utiliz-
ing four years' worth of routine clinical data. Users complet-
ing a course of guided self-help bibliotherapy (GSH),
internet-delivered cognitive behavioural therapy (iCBT) or
psychoeducational group therapy (PGT) from a stepped-care
service within the NHS in England were included. Propen-
sity score models (stratification and weighting) were used
to control for allocation bias and determine average treat-
ment effect (ATE) between the interventions. 21,215 users
comprised the study sample (GSH = 12,896, iCBT = 6862,
PGT = 1457). Adherence-to-treatment rates were higher in
iCBT. All interventions showed significant improvements
in depression (PHQ-9), anxiety (GAD-7) and function-
ing (WSAS) scores, with largest effect sizes for iCBT. Both
propensity score models showed a significant ATE in favour
of iCBT versus GSH and PGT, and in favour of GSH versus
PGT. Discernible differences in effectiveness were seen
for iCBT in comparison with GSH and PGT. Given vari-
ance in delivery mode and human resources between differ-
ent low-intensity interventions, building on these findings
A R T I C L E
Comparison of outcomes across low-intensity
psychological interventions for depression and
anxiety within a stepped-care setting: A naturalistic
cohort study using propensity score modelling
Jorge Palacios
1,2
| Adedeji Adegoke
1
| Rebecca Wogan
1
|
Daniel Duffy
1,2
| Caroline Earley
1,2
| Nora Eilert
1,2
|
Angel Enrique
1,2
| Sarah Sollesse
3
| Judith Chapman
3
|
Derek Richards
1,2
DOI: 10.1111/bjop.12614
Received: 18 June 2021
Accepted: 12 November 2022
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any
medium, provided the original work is properly cited.
© 2022 The Authors. British Journal of Psychology published by John Wiley & Sons Ltd on behalf of The British Psychological Society.
Br J Psychol. 2023;114:299–314. wileyonlinelibrary.com/journal/bjop
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