بررسی اثر منبع ارجاع بر روی نتیجه با رفتاردرمانی شناختی خودیاری

Little is known about how psychiatric patients' source of referral relates to treatment outcome. This study examines the effect of referral source on clinical outcome with computer-aided cognitive-behavior therapy (CCBT) for anxiety and depressive disorders. Three hundred fifty-five referrals to a clinic that offered CCBT with brief backup from a clinician were classified into general practitioner (GP) referrals (34%), mental health (MH) professional referrals (42%), and self-referrals (SR, 24%), and compared on sociodemographic and clinical features and treatment outcome. At intake, referrals from all 3 sources had similar sociodemographic features and problem duration, but GP referrals had less comorbidity, whereas MH professional referrals were being treated for their problem more often and were less motivated to change than were SR. Among treatment completers, SRs had the least and MH professional referrals had the most impaired work/social adjustment. Each referral group improved on generic and syndrome-specific measures; however, GP referrals improved the most and MH professional referrals the least. The 3 groups received similar therapist support and were equally satisfied after treatment. We conclude that GP referrals had the best outcome with CCBT for anxiety/depressive disorders. Referral source can be important in psychotherapy research because it may affect the type of patient seen and may predict treatment outcome.

In the UK and many other countries, referral to mental health (MH) services is most often done by general practitioners (GPs) who act as “gatekeepers,” followed by MH professionals and self-referrals (SR) [1] and [2]. In a UK survey, however, up to 70% of people with a neurotic disorder had not consulted their GP for their problem [3]. Lack of such consultation related especially to having more severe symptoms and disability, being male, having no physical illness, being older, having no partner, being South Asian, and working full time. Furthermore, less than 30% of people who consulted a GP were being treated for their problem, and this treatment was often not very appropriate [4]. Such findings challenge health service planners. Few studies report whether the source of referral of people with a neurotic disorder relates to their demographic and clinical features and outcome with treatment. In one study, people with anxiety disorders improved less with treatment including cognitive-behavior therapy (CBT) if the referral was from a psychiatrist rather than from a GP [5]. The present study reports relevant data from a clinic that offered computer-aided CBT (CCBT) self-help for anxiety/depression with brief backup from a clinician [6]. It received referrals from GPs, MH professionals, and SR. We tested whether the source of referral was related to pretreatment variables, motivation to do CCBT, and outcome and satisfaction with CCBT.