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The Lancet


Effectiveness of primary care psychological therapy services for treating depression and anxiety in autistic adults in England: a retrospective, matched, observational cohort study of national health-care records.

Last Revised:
PMID: 37977697
DOI: 10.1016/S2215-0366(23)00291-2
PII: S2215-0366(23)00291-2


The study explores the effectiveness of evidence-based psychological therapies for autistic adults experiencing anxiety or depression. Using a retrospective, matched, observational cohort study of national health-care records, it found that these therapies may be effective for autistic adults, albeit less effective than for adults without identified autism. Furthermore, the impact of sociodemographic factors, such as employment and socioeconomic status, on therapy outcomes appears to differ between autistic and non-autistic adults.

Key Takeaways

  • Evidence-based psychological therapies may be beneficial for autistic adults suffering from anxiety or depression, although they may be less effective than in non-autistic adults.
  • Sociodemographic factors like employment status and socioeconomic status that are typically associated with improved outcomes in non-autistic adults do not demonstrate the same correlation in autistic adults.
  • Further research is necessary to enable more personalized and targeted care for autistic individuals, considering the unique factors that may affect their therapy outcomes.

Latest Articles in Psychiatry


Céline El Baou, Georgia Bell, Rob Saunders, Joshua E J Buckman, William Mandy, Dave Dagnan, Elizabeth O'Nions, Richard Pender, Henry Clements, Stephen Pilling, Marcus Richards, Amber John, Joshua Stott

Full Abstract

  • BACKGROUND: Autistic adults report a higher prevalence of anxiety and depression than adults without identified autism but have poorer access to appropriate mental health care. Evidence-based psychological therapies are recommended in treatment guidelines for autistic adults, but no study has investigated their effectiveness in large samples representative of the autistic population accessing routine care. This study aimed to examine therapy outcomes for autistic adults in a primary care service.
  • METHODS: In this retrospective, matched, observational cohort study of national health-care records, we used the MODIFY dataset that used linked electronic health-care records, including national data, for individuals who accessed psychological therapy in primary care in Improving Access to Psychological Therapies (IAPT) services in 211 clinical commissioning group areas in England, UK. All adults aged 18 years or older who had completed a course of IAPT in 2012-19 were eligible, and were propensity score matched (1:1) with a comparison group without identified autism. Exact matching was used, when possible, for a range of sociodemographic factors. Primary outcomes were routine metrics that have been nationally defined and used to evaluate IAPT treatments: reliable improvement, reliable recovery, and reliable deterioration. Secondary outcomes were calculated pre-post treatment changes in scores for Patient Health Questionnaire-9, Generalised Anxiety Disorder Assessment-7, and Work and Social Adjustment Scale measures. Subgroup analyses investigated differential effects across a range of sociodemographic factors.
  • FINDINGS: 1·34, 1·18-1·48; p<0·0001). In the comparison group, improved outcomes were associated with employment and belonging to a higher socioeconomic deprivation category, but this was not the case for autistic adults.
  • INTERPRETATION: Evidence-based psychological therapy for depression or anxiety might be effective for autistic adults but less so than for adults without identified autism. Treatment moderators appear different for autistic individuals, so more research is needed to allow for better targeted and personalised care.
  • FUNDING: Alzheimer's Society.


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