10 March 2021

Gabriella Bergin-Cartwright, Integrating Mental and Physical healthcare: Research, Training and Services (IMPARTS) Research Assistant [pictured below], shares five key learnings from IMPARTS research.

Evidence shows that mind and body health are inseparable. Around one third of people with a long-term physical health condition also have a mental health condition, and this overlap can make the management of both more complicated.

We know that when healthcare is considered holistically, patients improve. However, typically, our mental and physical health systems work separately, not reflecting the constant conversation between our mind and body.

Our IMPARTS programme seeks to bridge the divide by integrating the detection, documentation, and management of mental health in physical health settings. IMPARTS directly supports clinical teams to provide more holistic care to patients, including through the routine collecting of patient reported outcomes. The data collected covers a variety of aspects of mental and physical health outcomes, and this creates many opportunities for research and development that can improve care.

This blog reflects on findings from more than seven years and around 20 publications of IMPARTS research.

1. Patients are engaged with integrated care initiatives, like IMPARTS

In 2013, the concept of IMPARTS was introduced into academic literature. This included data showing that web-based screening of mental and physical health can be effectively embedded into routine care. Since then, studies have found that, when implemented enthusiastically, as many as nine out of 10 patients invited to do so complete the IMPARTS survey and only around 5% decline, although this is not universal. Clinical teams working in neuro-otology, temporomandibular disorders, dermatology, and others, have published their reflections on implementing IMPARTS, including how it has helped them to identify service need, monitor patient outcomes, and aid holistic treatment. These findings have helped to show how identifying and managing mental health in physical settings can be both feasible for patients and valuable for clinical teams. 

2. Psychological distress is common in patients with long-term physical conditions

IMPARTS research has helped to reveal the sizeable overlap between mental and physical health conditions. On average, studies have found that around one fifth of outpatients with long-term physical conditions meet criteria for a probable mental health condition. In a study using data across 10 services using IMPARTS and 7,878 patients, 23.3% met criteria for probable depression and 18.5% probable anxiety.

These findings can vary widely across conditions. For example, in a sample of patients with complex chronic pain, depression was recorded in 60.8% of people, whereas in a sample of patients with psoriasis, 9.9% screened positive for depression. The high rate and variation of psychological distress across settings shows the importance of asking about mental health in individual clinics and adapting support accordingly.

3. Mental health can predict outcomes

Studies using IMPARTS data have looked at how mental and physical health interact and have found that an overlap of conditions can be costly for patients and require extensive NHS resource, making evident the need for action.

  • Physical symptoms and functioning

In patients undergoing limb reconstruction, a study found those who met criteria for depression, anxiety or post-traumatic stress disorder (PTSD) reported more pain, fatigue, and disability. It also found that having probable depression or anxiety independently impacted people’s ability to work. A study of patients with chronic pain similarly found that people who also had depression reported more pain, more pain-related interference with functioning, and were more likely to be unable to work. Clearly, identifying and managing mental health in these settings could have a positive impact on the physical, emotional, and occupational aspects of people’s lives.

  • Negative health behaviours

As well as screening for mental and physical health, IMPARTS asks about health behaviours such as smoking. Analysis of data across multiple services revealed that common mental disorder in patients with long-term conditions is a risk factor for smoking and higher levels of nicotine dependence. Interestingly, the presence of depression or anxiety did not affect the likelihood that people would want help with stopping smoking. Therefore, a strength of IMPARTS is its ability to regularly update smoking status in case notes and present patients with the information they need to support with quitting.

  • Increased healthcare costs

A study analysing data from patients with chronic complex pain found a significant link between severe depression and total health care costs, where the mean total cost per three-month period was around £283 more for patients with depression compared to those without depression. This initial data suggests that joined-up care that effectively treats depression may not only improve patient health and functioning, but may also improve the cost-effectiveness of health services. 

4. Considering mental and physical health together can inform treatment

  • Empowering patients

An important component of health is self-management. While there are lots of self-help resources available for depression and anxiety, there are few that address the mind and body link in the context of long-term conditions. Research by IMPARTS systematically reviewed the evidence for self-help and found that written materials can help to relieve symptoms of depression in people who have physical conditions. Those based on therapeutic models like cognitive behavioural therapy and that include material on stress-management may be particularly effective. IMPARTS has now developed a selection of self-help resources that are tailored to people living with health conditions and the challenges that can bring. Topics include help on staying active and managing stress or worry, as well specific challenges like breathlessness and anxiety in lung disease.

  • Addressing psychological aspects in care

IMPARTS research has uncovered interesting relationships that may help to inform approaches to treatment. For example, a study of data from patients with skin condition Hidradenitis Suppurativa found that people’s beliefs about their illness, rather than the severity of their condition, were more strongly linked with depression, anxiety and quality of life. For young people with liver disease, specific beliefs about illness and treatment were also found to relate to higher levels of depression and anxiety.

These findings tell us the importance of joining up mental and physical health in the information and support we provide to patients, and the relevance of considering people’s thoughts and feelings in treatment.

5. There is exciting scope for further work

A lot of valuable research has and continues to be undertaken with IMPARTS data, and there are still many avenues to explore. The routine collection of patient reported outcomes in services across King’s Health Partners, and the frequent follow-up of patients, means it is possible to investigate how health may change over time, including how certain interventions might affect people’s mental and physical well-being.

IMPARTS and the database is growing, meaning we will hopefully be able to uncover the rate of mental health difficulties across more settings, and reveal more about how mental and physical health interact. Embedding the IMPARTS infrastructure has also previously enabled researchers to explore things beyond strictly mental health, including testing new measures, detecting and describing new symptoms, and recruiting to trials.

IMPARTS goal is to make mind and body care a reality, and research plays an important part in this ambition. Studies generate findings that grow and develop the evidence-base for integrated care and help to develop services to better understand and meet the needs of the patients they see.

Read a full list of IMPARTS publications and find out more about IMPARTS research.

Liked this story? Read changing the story on children’s mental health.