Physical long‐term conditions and psychological treatment outcomes in NHS Talking Therapies: Prevalence, impact, and moderators

OBJECTIVE: This study examined the impact of having one or multiple physical long-term conditions (LTCs) on treatment outcomes and engagement with NHS Talking Therapies (NHS-TT), focusing on clinical and treatment-related moderators. METHODS: A retrospective cohort design was applied to routine data from 44,957 patients discharged from seven NHS-TT services in Northwest England between September 2021 and September 2024. Logistic regression analyses assessed the impact of LTC status (none, one or multiple LTCs) on reliable recovery-defined as clinically significant improvement in both depression and anxiety scores-and treatment engagement, operationalised as planned discharge versus dropout. Moderation analyses explored the influence of provisional diagnosis, baseline functional impairment, treatment intensity and mode of therapy delivery. RESULTS: LTCs were reported by 47.5% of patients, with 9.4% reporting multiple LTCs. Patients with LTCs had lower odds of reliable recovery (OR = 0.83), with further reductions among those with multimorbidity (OR = 0.71). Conversely, LTC status was associated with higher odds of planned discharge (OR = 1.28). The negative association with reliable recovery was attenuated among patients with depression (OR = 1.21) but exacerbated for those with mixed anxiety and depression (OR = 0.71), who also had lower odds of planned discharge (OR = 0.66). CONCLUSION: Multimorbidity is associated with poorer clinical outcomes despite higher treatment engagement. Tailored care pathways are needed to better support patients with LTCs.