Is there a prospective association between psychological distress as measured by the CORE-OM and treatment attendance and treatment duration? A follow-up study at a Norwegian Community Mental Health Centre

Figures & data

Table 1. Sociodemographic and clinical characteristics of the valid sample (N = 124).

Variable	M	SD	Range
Age^a	34	13.0	18–75
Waiting time (months)^b	2.4	1.48	0–8
		N	%
Sex	Female	73	59
	Male	51	41
Civil status	Single	42	34
	Married	34	27
	Co-habiting	33	27
	Separated/divorced	6	5
	Widow(-er)	2	1.6
	Missing information	7	6
Living situation	Living alone	24	21
	Living with others	92	79
	Missing information	8	7
Education	≤ 9 years	19	16
	High school	60	51
	College/university	27	23
	Other higher education	12	10
	Missing information	6	5
Employment	Employed	44	37
	Sick leave/pension/out of work	41	35
	Student/other	33	28
	Missing information	6	5
Immediate medical assistance/acute help	Acute help	2	1.8
	Ordinary	108	87
	Missing information	14	11
Primary diagnosis (ICD-10)	F0–F9 dementia/organic condition	1	1
	F10–F19 substance use	6	5
	F20–F29 schizophrenia etc.	2	2
	F30–F31 mania/bipolar	3	3
	F32–F33 depressive disorders	27	24
	F40 phobic disorders	10	9
	F41 anxiety	13	11
	F42–F48 various anxiety disorders	36	32
	F50–F98, Z, miscellaneous	16	14
	Missing information	10	8
Alcohol-related problems^c	Yes	25	20
	No	74	60
	Missing information	25	20
Drug-related problems^d	Missing information	8	7%
Medication	No medications	61	49
	Antipsychotics	7	6
	Antidepressants	42	37
	Anxiolytics or hypnotics	14	11
	Missing information	7	6
Treatment format	Individual only	56	90
	Group only	10	8
	Both individual and group	58	47
Current use of services for psychological problems?	General practitioner	83	67
	Home care services	6	4.8
	Ambulatory care at CMCH	124	100
	Private psychiatrist/psychologist	2	1.6
	Hospitalised during the last 10 days	6	4.8
	Psychiatric day care	0	0
	Community mental health nurse	22	18
	Missing information	0	0

M: mean; SD: standard deviation; ICD-10: International Statistical Classification of Diseases and Related Health Problems, 10^th revision.

^a Four participants with missing responses.

^b One participant with missing response.

^c Frequency of respondents scoring above Alcohol Use Disorders Identification Test (AUDIT) cut-off of 8 for men and 6 for women for medium level of alcohol problems (WHO: [13]).

^d Frequency of respondents scoring above Drug Use Disorders Identification Test (DUDIT) cut-off of 6 for men and 2 for women for drug related problems [14].

Table 2. Patient-reported psychological distress as measured by CORE-OM item scores^a, domain subscales and total scale (N = 124).

	Item	Domain (item cluster)	M	SD	Range
1	I have felt terribly alone and isolated.	Functioning (close relationships)	1.53	1.03	0–4
2	I have felt tense, anxious or nervous.	Problems/symptoms (anxiety)	2.42	0.91	0–4
3	I have felt I have someone to turn to for support when needed.^a	Functioning (close relationships)	1.48	1.06	0–4
4	I have felt OK about myself.^a	Well-being	2.44	0.78	0–4
5	I have felt totally lacking in energy and enthusiasm.	Problems/symptoms (depression)	2.49	0.99	0–4
6	I have been physically violent to others.	R-others	0.10	0.34	0–2
7	I have felt able to cope when things go wrong.^a	Functioning (general)	1.7	0.89	0–4
8	I have been troubled by aches, pains or other physical problems.	Problems/symptoms (physical problems)	2.1	1.24	0–4
9	I have thought of hurting myself.	R-self	0.6	0.95	0–4
10	Talking to people has felt too much for me.	Functioning (social relationships)	1.60	1.03	0–4
11	Tension and anxiety have prevented me doing important things.	Problems/symptoms (anxiety)	1.6	1.15	0–4
12	I have been happy with the things I have done.^a	Functioning (general)	2.0	0.77	0–4
13	I have been disturbed by unwanted thoughts and feelings.	Problems/symptoms (trauma)	2.3	1.11	0–4
14	I have felt like crying.	Well-being	2.2	1.02	0–4
15	I have felt panic or terror.	Problems/symptoms (anxiety)	1.5	1.02	0–4
16	I made plans to end my life.	R-suicidal	0.3	0.65	0–3
17	I have felt overwhelmed by my problems.	Well-being	2.0	1.02	0–4
18	I have difficulty getting to sleep or staying asleep.	Problems/symptoms (physical problems)	2.2	1.22	0–4
19	I have felt warmth and affection for someone.^a	Functioning (close relationships)	1.5	1.00	0–4
20	My problems have been impossible to put to one side.	Problems/symptoms (anxiety)	2.2	1.01	0–4
21	I have been able to do most things I needed to.^a	Functioning (general)	1.8	0.99	0–4
22	I have threatened or intimidated another person.	R-others	0.3	0.71	0–3
23	I have felt despairing or hopeless.	Problems/symptoms (depression)	1.8	1.03	0–4
24	I have thought it would be better if I were dead.	R-suicidal	0.9	1.10	0–4
25	I have felt criticised by other people.	Functioning (social relationships)	1.7	1.06	0–4
26	I have thought I have no friends.	Functioning (close relationships)	1.1	1.15	0–4
27	I have felt unhappy	Problems/symptoms (depression)	2.1	1.03	0–4
28	Unwanted images or memories have been distressing me.	Problems/symptoms (trauma)	1.8	1.19	0–4
29	I have been irritable when with other people.	Functioning (social relationships)	1.7	1.00	0–4
30	I have thought I am to blame for my problems and difficulties.	Problems/symptoms (depression)	2.2	1.12	0–4
31	I have felt optimistic about my future^a	Well-being	2.1	0.94	0–4
32	I have achieved the things I wanted to^a	Functioning (general)	1.99	0.78	0–4
33	I have felt humiliated or shamed by other people	Functioning (social relationships)	1.00	0.98	0–3
34	I have hurt myself physically or taken dangerous risks with my health	R-self	0.4	0.69	0–3
	Domain	Scale	M	SD	Range
	Subjective well-being (4 items)	W	2.19	0.66	0.00–3.75
	Problems/symptoms (12 items)	P	2.06	0.67	0.00–3.92
	Functioning (12 items)	F	1.60	0.52	0.00–2.83
	Risk (6 items)	R	0.42	0.54	0.00–2.33
	Non-risk (28 items)	NR	1.88	0.54	0.00–3.43
	All (34 items)	All	1.62	0.50	0.00–3.06

M: mean; SD: standard deviation.

W: Well-being; P: Problems/Symptoms; F: Functioning; NR: Non-risk; R: Risk.

^a All item scores presented in the table are scored so that ‘0’ means ‘Never’ and ‘4’ means ‘Almost all the time’. Eight positively phrased items (items 3, 4, 7, 12, 19, 21, 31 and 32) are shown as reverse scaled compared to how they originally were scaled in the questionnaire, that is, above ‘4’ means ‘Never’ and ‘0’ means ‘Almost all the time’.

Table 3. Treatment duration, number of sessions offered and attended and termination of treatment (N = 124).

	Treatment duration (months) (N = 124)		Number of sessions attended (N = 122)		Number of sessions offered (N = 122)		Number of ‘no-show’ sessions (N = 122)		Number of sessions attended/offered (N = 122)
Group	M (SD)	Md (range)	M (SD)	Md (range)	M (SD)	Md (range)	M (SD)	Md (range)	M (SD)	Md (range)
Individual treatment only (N = 56)^a	12.6 (8.94)	10.9 (0.5–52.2)	13.7 (9.68)	12.0 (2–52)	18.5 (12.44)	16.0 (3–63)	4.9 (4.76)	3.0 (0–24)	0.75 (0.18)	0.76 (0.29–1.00)
Group treatment only (N = 10)	11.3 (5.06)	10.3 (3.5–19.9)	25.3 (18.19)	22.5 (6–58)	31.6 (18.60)	26.5 (8–65)	6.2 (4.24)	5.5 (1–15)	0.76 (0.20)	0.86 (0.32–0.95)
Individual and group treatment (N = 58)	15.6 (10.40)	13.2 (1.8–50.7)	38.2 (29.18)	31.0 (3–149)	49.3 (35.33)	39.5 (7–166)	10.9 (9.47)	7.5 (0–49)	0.76 (0.16)	0.79 (0.42–1.00)

M=mean; SD=standard deviation; Md=median.

^a Descriptive statistics include only 54 patients with valid data on number of sessions.

Table 4. Linear regression models with CORE subscales as predictor variables and treatment duration, number of therapy sessions and treatment attendance (number of therapy sessions attended/offered) as outcome variables (N = 124).

	Outcome variable	Predictor variable
Model	Treatment duration (months) (N = 124)	Subjective well-being (4 items)	Problems/ symptoms (12 items)	Functioning (12 items)	Risk (6 items)	Non-risk (28 items)	All (34 items)
Crude	B	3.3	2.9	3.4	4.0	4.0	4.7
	95% CI for B	0.83; 5.83	0.43; 5.44	0.15; 6.62	0.91; 7.09	0.90; 7.06	1.34; 7.96
	P^a	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05
Adj. age	B	3.2	2.9	3.2	3.8	3.8	4.5
	95% CI for B	0.73; 5.74	0.36; 5.37	−0.13; 6.44	0.53; 7.04	0.73; 6.93	1.10-7.80
	P^a	<0.05	<0.05	0.055	<0.05	<0.05	<0.05
Adj. gender	B	3.4	3.0	3.4	4.3	4.0	4.7
	95% CI for B	0.85; 5.87	0.43; 5.46	0.18; 6.68	1.16; 7.49	0.93; 7.11	1.40;8.06
	P^a	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05
Adj. education	B	3.4	3.0	3.4	4.1	4.1	4.8
	95% CI for B	0.85; 5.97	0.44; 5.60	0.12; 6.65	0.91; 7.21	0.92; 7.22	1.39; 8.17
	P^a	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05
Fully adj.	B	3.4	3.00	3.2	4.2	4.0	4.7
	95% CI for B	0.80; 5.94	0.42; 5.59	−0.10; 6.55	0.83; 7.61	0.81; 7.16	1.24; 8.14
	P^a	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05
	Total number of therapy sessions (N = 122)
Crude	B	4.8	3.7	0.5	3.9	3.8	4.5
	95% CI for B	−2.02; 11.69	−3.13; 10.61	−8.36;9.31	−4.42; 12.21	−4.76; 12.35	−4.74; 13.72
	P^a	0.139	0.363	0.899	0.416	0.419	0.375
Adj. age	B	4.8	3.7	0.5	4.2	3.8	4.5
	95% CI for B	−2.05; 11.73	−3.16; 10.64	−8.50; 9.42	−4.52; 12.92	−4.82; 12.42	−4.80; 13.89
	P^a	0.141	0.366	0.904	0.405	0.422	0.376
Adj. gender	B	5.2	4.0	1.1	6.12	4.3	5.4
	95% CI for B	−1.54; 11.98	−2.78; 10.78	−7.65; 9.82	−2.25; 14.49	−4.15; 12.74	−3.70; 14.56
	P^a	0.098	0.304	0.760	0.144	0.329	0.245
Adj. education	B	5.5	4.5	0.8	4.6	4.5	5.4
	95% CI for B	−1.45;12.42	−2.51; 11.47	−8.10; 9.63	−3.85; 12.96	−4.15; 13.18	−4.01; 14.71
	P^a	0.109	0.296	0.864	0.360	0.358	0.313
Fully adj.	B	5.9	4.8	1.3	7.3	5.0	6.4
	95% CI for B	1.00;12.75	−2.16;11.68	−7.56; 10.21	−1.56; 16.16	−3.58;13.63	−3.01; 15.70
	P^a	0.076	0.243	0.734	0.108	0.279	0.199
	Number of sessions attended/offered (N = 112)
Crude	B	−0.02	−0.00	−0.05	−0.03	−0.03	−0.03
	95 % CI for B	−0.07; 0.03	−0.06; 0.05	−0.12; 0.02	−0.09;0.03	−0.09; 0.04	−0.10; 0.04
	P^a	0.365	0.805	0.148	0.214	0.366	0.295
Adj. age	B	−0.02	−0.00	−0.04	−0.02	−0.02	−0.02
	95% CI for B	−0.07; 0.04	−0.05;0.05	−0.11; 0.03	−0.08; 0.05	−0.09; 0.04	−0.09; 0.05
	P^a	0.410	0.833	0.228	0.459	0.445	0.411
Adj. gender	B	−0.02	−0.00	−0.05	−0.02	−0.02	−0.03
	95% CI for B	−0.07; 0.04	−0.05; 0.05	−0.11; 0.02	−0.09; 0.04	−0.09; 0.04	−0.10; 0.04
	P^a	0.406	0.849	0.176	0.360	0.411	0.364
Adj. education	B	−0.02	−0.00	−0.05	−0.03	−0.03	−0.03
	95% CI for B	−0.07; 0.04	−0.06; 0.05	−0.12; 0.02	−0.09; 0.04	−0.09; 0.04	−0.10, 0.04
	P^a	0.427	0.912	0.163	0.253	0.425	0.351
Fully adj.	B	−0.02	0.00	−0.04	−0.00	−0.02	−0.02
	95% CI for B	−0.07;0.04	−0.05; 0.05	−0.11;0.03	−0.07; 0.07	−0.08; 0.05	−0.10; 0.05
	P^a	0.507	0.961	0.284	0.759	0.549	0.553

CI: confidence interval.

^a P values are reported from analyses performed with transformed variables. Effect sizes and 95% confidence intervals (CIs) are reported from analyses with variables that were not transformed.

Figure 1. Duration of treatment (months in intervals) (N = 124).

Figure 2. Frequency of individual therapy sessions attended (frequencies in intervals) (N = 112).

Table 5. Logistic regression model with CORE-OM scales as predictor variables and termination of treatment^a (planned versus unplanned) as the outcome variable (N = 124).

Model	Estimates	Subjective well-being (4 items)	Problems/symptoms (12 items)	Functioning (12 items)	Risk (6 items)	Non-risk (28 items)	All (34 items)
Crude	OR	1.3	0.9	1.1	1.7	1.1	1.1
	95% CI for OR	0.51; 3.13	0.37; 2.40	0.33; 3.64	0.42; 6.72	0.33; 3.30	0.33; 3.95
	P	0.604	0.889	0.881	0.465	0.940	0.835
Adj. age	OR	1.3	0.9	1.0	1.6	1.0	1.1
	95% CI for OR	0.50;3.13	0.36; 2.37	0.31; 3.47	0.38; 6.61	0.32; 3.20	0.31; 3.81
	P	0.633	0.872	0.954	0.535	0.986	0.899
Adj. gender	OR	1.3	0.9	1.0	1.3	1.0	1.1
	95% CI for OR	0.47; 3.42	34; 2.42	0.30; 3.58	0.34;5.13	0.30; 3.37	0.28; 3.93
	P	0.637	0.851	0.955	0.679	0.997	0.935
Adj. education	OR	1.3	0.9	1.1	1.7	1.1	1.2
	95% CI for OR	0.51; 3.30	0.36; 2.47	0.33; 3.70	0.43; 6.89	0.33; 3.42	0.33; 4.14
	P	0.582	0.906	0.871	0.449	0.921	0.814
Fully adj.	OR	1.3	0.9	1.0	1.3	1.0	1.0
	95% CI for OR	0.46; 3.50	0.33; 2.56	0.29; 3.48	0.31; 5.06	0.29; 3.48	0.27; 0.04
	P	0.639	0.871	0.999	0.758	0.994	0.960

^a Planned termination of treatment = reference category.

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Data availability statement

Data are available upon reasonable request.