# Current treatment outcomes and care pathways for people with comorbid physical and mental health conditions using NHS Talking Therapies services in the UK: systematic review of quantitative studies

## TL;DR

This study reviews the effectiveness of NHS Talking Therapies for people with long-term physical conditions and mental health issues, finding some benefits but highlighting the need for more research.

## Contribution

The study provides a systematic review and meta-analysis of NHS TT effectiveness for individuals with comorbid physical and mental health conditions.

## Key findings

- NHS TT showed significant improvement in mental health outcomes for people with long-term conditions.
- There was no significant difference in treatment engagement between those with and without long-term conditions.
- High heterogeneity among studies suggests variability in results and the need for further research.

## Abstract

In 2018, the UK government commissioned National Health Service Talking Therapies (NHS TT) services to provide integrated mental and physical health care for individuals with a long-term condition (LTC) and coexisting depression and/or anxiety. Nevertheless, evidence on the effectiveness of NHS TT in physical LTCs remains inconsistent.

This review aims to evaluate the impact of NHS TT on mental health outcomes among adults with physical LTCs.

We conducted a systematic review and meta-analysis of quantitative studies published between 2008 and 2024. We used several databases for the search, including Embase, MEDLINE, Cochrane Library, NHS Evidence, PsycINFO, Bielefeld Academic Search Engine and ProQuest. We combined terms related to NHS TT, LTCs and mental health outcomes to identify eligible studies. The Population, Intervention, Comparison, Outcomes and Study framework guided the development of the inclusion criteria. We employed the random-effects model for meta-analysis and assessed heterogeneity bias using the I
2 statistic, and the Newcastle–Ottawa scale to evaluate the overall quality of the evidence.

Twenty-four studies met the inclusion criteria. The meta-analysis revealed a significant pre–post NHS TT intervention effect on reliable improvement (odds ratio 0.77, 95% CI: 0.60–0.98) and reliable recovery (odds ratio 0.80, CI: 0.68–0.95). There were no significant differences in NHS TT accessibility (e.g. treatment engagement) between participants with and without LTCs (odds ratio 0.97, 95% CI: 0.82–1.14). However, heterogeneity between the studies was high (>90%).

The observed evidence provides reassurance for individuals with LTCs engaging with treatment; however, the association with post-treatment distress is still of concern. Furthermore, extensive and rigorous research is needed to strengthen and guide service development for individuals with LTCs, thereby improving effectiveness.