Affiliation:
1. Imperial College London
2. University of Nottingham
3. Swinburne University of Technology
Abstract
Abstract
Purpose
To examine the nature of positive and negative environmental change on clinical outcome in 210 patients presenting with anxiety and depression and followed up over 30 years.
Methods
In addition to clinical assessments, major environmental changes, particularly after 12 and 30 years, were recorded in all patients by a combination of self-report and taped interviews. Environmental changes were separated into two major groups, positive or negative, determined by patient opinion.
Results
Using a combined measure of clinical and social outcomes positive and negative environmental changes were compared. Positive changes were more likely than negative ones to be associated with a good outcome at 12 and 30 years (39% v 3.6% and 30.2% v 9.1% respectively). Similar greater improvement in accommodation (P = 0.009), relationships (P = 0.007), and substance use (p = 0.003) were found with positive changes at 12 years, and psychiatric admissions P = 0.011 (12 years) and social work contacts (P = 0.043)(30 years) were also similarly reduced. Those with personality disorder at baseline had fewer positive changes (P = 0.018) than others at 12 years and fewer positive occupational changes at 30 years (P = 0.041). Service use was greatly reduced in those with positive events with 50–80% more time free of all psychotropic drug treatment (P < 0.001). Instrumental positive change had greater effects than imposed changes.
Conclusions
Positive environmental change has a favourable impact on clinical outcome in common mental disorders. Although studied naturalistically in this study the findings suggest that if harnessed as a therapeutic intervention, as in nidotherapy and social prescribing, it would yield therapeutic dividends.
Publisher
Research Square Platform LLC