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. 2025 Sep 5;16(1):2547549. doi: 10.1080/20008066.2025.2547549

On poverty and trauma: associations between neighbourhood socioeconomic deprivation, post-traumatic stress disorder severity and treatment response

Sobre la pobreza y el trauma: asociaciones entre la privación socioeconómica del vecindario, la gravedad del trastorno de estrés postraumático y la respuesta al tratamiento

Jaime Delgadillo a,CONTACT, Thomas Richardson b
PMCID: PMC12415998  PMID: 40910182

ABSTRACT

Aims: To determine if neighbourhood socioeconomic deprivation is associated with post-traumatic stress disorder (PTSD) severity and psychological treatment response.

Methods: This was a retrospective cohort study based on the analysis of electronic health records for N = 2064 patients treated for PTSD across 16 psychological therapy services in England. The Revised Impact of Events Scale (IES-R) scale was used to measure PTSD severity and associations were examined with the neighbourhood-level index of multiple deprivation (IMD) using non-parametric correlations and multilevel modelling.

Results: Three times more PTSD cases (33.6% vs. 9.7%) were clustered within the most deprived IMD quintile compared to the least deprived quintile. A small and statistically significant correlation between IMD and IES-R baseline severity (r = −0.16, p < .001), indicated that patients living in the most deprived neighbourhoods had more severe symptoms. Post-treatment IES-R severity was also significantly associated with IMD (B = −0.74, p < .001), after controlling for baseline severity of PTSD and comorbid depression symptoms, adjusting for between-service variability in treatment outcomes (ICC = 0.023). Treatment duration was a moderator of the association between IMD and treatment outcomes.

Conclusions: Neighbourhood deprivation is associated with a higher prevalence of PTSD, higher symptom severity at the start of treatment and poorer treatment response. A longer course of therapy mitigated the adverse impact of deprivation on treatment outcomes.

KEYWORDS: Post-traumatic stress disorder, PTSD, CBT, EMDR, psychotherapy, socioeconomic deprivation, socioeconomic status, unemployment, poverty

HIGHLIGHTS

  • Most patients seeking psychological therapy for PTSD tended to live in socioeconomically deprived neighbourhoods.

  • Patients living in deprived neighbourhoods had more severe symptoms of PTSD before therapy, compared to those living in more economically advantaged neighbourhoods.

  • Patients living in deprived neighbourhoods also had poorer treatment response, unless they received lengthier interventions – which improved outcomes.

1. Introduction

Socioeconomic deprivation refers to a situation of scarcity and lower quality of life relative to general population norms. This is a multi-faceted concept proposed to encompass disadvantages related to education, employment, income, crime, access to services and the quality of housing and the living environment (Smith et al., 2015; Townsend, 1987). A large body of research has documented associations between socioeconomic deprivation and mental health problems. For example, numerous empirical studies and reviews of this literature indicate that indices of socioeconomic deprivation are associated with the onset (Kivimäki et al., 2020), prevalence and severity of common mental health problems (Fryers et al., 2003; Silva et al., 2016). Several variables related to socioeconomic status have been found to be associated with depression and anxiety disorders, including economic recessions (Frasquilho et al., 2015), energy poverty (Bentley et al., 2023), debt (Richardson et al., 2013), the use of short-term loans (Sweet et al., 2018), financial strain (Dijkstra-Kersten et al., 2015), job insecurity and unemployment (Kim & von Dem Knesebeck, 2016). These convergent findings provide ample evidence that socioeconomic status is associated with depression and anxiety severity, although fewer studies have examined the socioeconomic correlates of other mental disorders.

Post-Traumatic Stress Disorder (PTSD) is a mental health problem characterised by symptoms such as flashbacks, nightmares, strong emotional reactions and avoidance of reminders of the trauma (World Health Organization, 2022). According to an analysis of the World Health Organization World Mental Health Surveys, the global lifetime prevalence of PTSD is 3.9% in the general population, with wide differences between countries (Koenen et al., 2017). This study indicates that low income is associated with higher rate of exposure to adverse events and higher lifetime prevalence of PTSD. Similarly, systematic reviews have suggested that lower socioeconomic status increases the risk of developing PTSD after earthquakes (Tang et al., 2017), and lower income increases the risk of PTSD following physical trauma (Visser et al., 2017). Neighbourhood poverty has been found to prospectively predict the incidence of PTSD following trauma exposure (Bhatt et al., 2017; George et al., 2023; Ravi et al., 2023). An investigation of mental health in veterans found that those with mental health problems (including PTSD) tended to live in more deprived neighbourhoods (Murphy et al., 2017). Similarly, studies have shown increased risk of developing PTSD in crime victims with financial difficulties (van der Velden et al., 2023). A study in the United Kingdom found that unemployment was a risk factor for PTSD (McManus et al., 2016), though the World Health Organization found that across many countries socio-economic status did not predict PTSD (Kessler et al., 2017).

Trauma-focussed psychological interventions such as cognitive–behavioural therapy, cognitive processing therapy, eye-movement desensitisation and reprocessing (EMDR), are recommended first-line interventions for PTSD according to clinical guidelines (Martin et al., 2021). Although converging lines of evidence indicate that socioeconomic variables are associated with the incidence of PTSD, it is unclear whether socioeconomic deprivation may adversely impact treatment outcomes. An individual patient data meta-analysis found that psychological therapies for PTSD were less effective for those who were unemployed (Wright et al., 2024). An analysis of psychological therapy outcomes data from the English National Health Service (NHS) found that those who lived in socioeconomically deprived neighbourhoods had poorer psychological treatment outcomes (Finegan et al., 2020). Compared to patients living in more affluent neighbourhoods, those living in deprived neighbourhoods had higher mean levels of depression and anxiety symptom severity at the end of treatment, after controlling for baseline severity and other confounding variables. However, this study did not examine PTSD outcomes specifically. A more recent study including data from patients treated in the NHS found that neighbourhood deprivation was not associated with PTSD severity at the start of treatment, however those living in more deprived areas experienced less of a reduction in PTSD symptoms after treatment (Richardson et al., 2025). However, this study was based on a relatively small sample (N = 138) from a single city. Such a restricted sample and geographical spread may limit the range of socioeconomic and cultural diversity, resulting in a more homogeneous sample by comparison to a multi-city study.

The present study aimed to examine associations between socioeconomic deprivation, PTSD symptom severity and psychological treatment response. The study was designed to replicate and extend the work by Richardson et al. (2025) with a larger sample and across other geographical locations not included in the prior study. Three hypotheses were tested in this study. We expected that [H1] most patients referred for PTSD treatment would be living in deprived neighbourhoods. Furthermore, we expected that the gradient of socioeconomic deprivation would be linearly associated with PTSD severity [H2] at pre-treatment and [H3] post-treatment assessments.

2. Method

2.1. Design and ethical approval

This retrospective cohort study was based on the analysis of routinely collected clinical care records from the National Health Service (NHS) in England. The assembly and analysis of this dataset was approved by the North East-Newcastle & North Tyneside NHS research ethics committee and the Health Research Authority (REC Reference: 15/LO/2200), and approved as a secondary data analysis by the University of Southampton ethics committee (reference 90598).

2.2. Setting, interventions and eligibility criteria

Electronic health records for patients who presented with symptoms of PTSD were collected from psychological services covering London, Yorkshire & Humber, Cambridgeshire, Cheshire and Lancashire. These services were part of the national NHS Talking Therapies1 programme in England (Clark, 2011), which offers evidence-based psychological interventions for common mental health problems following clinical guidelines (National Institute for Health and Care Excellence, 2011). In accordance with these guidelines, patients with PTSD symptoms were offered up to 20 sessions of trauma-focused cognitive behavioural therapy (CBT), or eye-movement desensitisation and reprocessing (EMDR), delivered by qualified psychotherapists. Treatment assignment is usually made by the clinician who undertakes an initial assessment at the time when patients are referred to the service. The presence of PTSD symptoms is assessed via a semi-structured assessment interview and supplemented by a psychometric assessment (explained below). Following a shared decision-making process, the assessing clinician would briefly explain the available treatment options for PTSD and assign the patient based on their preference for CBT or EMDR.

This study included anonymised clinical and demographic data for a consecutive of sample of adult (aged ≥18) treatment-seeking patients who presented with PTSD symptoms and whose treatment episode concluded within a 2-year data collection period.

2.3. Measures

The primary outcome was PTSD symptom severity, which was measured using the Impact of Event Scale-Revised (IES-R; Weiss, 2007). This is a 22-item questionnaire that measures typical symptoms of PTSD clustered into three domains: intrusion (8 items), hyperarousal (6 items), avoidance (8 items). Items are scored using a 5-point Likert scale denoting distress (0-4), yielding a sum score between 0 and 88. The scale has been found to have high internal consistency (Cronbach’s alpha = 0.96), good convergent validity (r = 0.84 correlation with the PTSD Checklist), and adequate sensitivity (0.91) and specificity (0.82) to screen for a probable diagnosis of PTSD using a cut-off ≥33 (Creamer et al., 2003). A reliable change index of ≥9 points has been recommended as an indication of statistically reliable change that is unlikely to be solely due to measurement error (NHS England, 2014).

Socioeconomic deprivation was measured using the Index of Multiple Deprivation (IMD; Smith et al., 2015), which ranks neighbourhoods in England from the most to the least deprived, based on seven area-level indicators: income, unemployment, education level, health and disability, crime, barriers to housing and services, and quality of the local environment. IMD scores can be clustered into deciles (where 1 = most deprived, 10 = least deprived areas), representing relative neighbourhood deprivation levels using an ordinal variable. Neighbourhoods were defined using the UK government concept of a Lower Layer Super Output Area (LSOA), each approximating 1500 residents or 650 households (Ministry of Housing, Communities & Local Government, 2019).

Depression symptoms were assessed using the Patient Health Questionnaire (PHQ-9; Kroenke et al., 2001), where each of nine items is rated on a 0–3 Likert scale denoting symptom frequency in the last two weeks, yielding an overall severity score between 0 and 27. Anxiety symptoms were assessed using the Generalised Anxiety Disorder questionnaire (GAD-7; Spitzer et al., 2006), where each of seven items is rated on a 0–3 Likert scale yielding an overall severity score between 0 and 21. Functional impairment was assessed using the Work and Social Adjustment Scale (WSAS; Mundt et al., 2002) which rates functioning across five domains: work, home management, social life, private leisure activities, and family relationships. A severity score is derived from the sum of five Likert scales (0–8), yielding a functional impairment score between 0 and 40. Psychometric measures listed above were collected by clinicians as part of a standard routine outcome monitoring process (Clark, 2011); only intake and last-observed measures were collected as part of this study database. Additional data sources included demographic characteristics (age, gender, ethnicity, employment status).

2.3.1. Sample selection and characteristics

The study sample included clinical records for patients who [1] were screened for PTSD using the IES-R scale at their initial assessment, [2] were deemed eligible for psychological therapy in this setting, [3] attended at least 1 session of trauma-focused therapy (either CBT or EMDR) after the intake assessment, [4] had been discharged by the service by the time of data collection. Records for patients who completed treatment and those who dropped out were included in analysis, following intention-to-treat principles. Patients completed session-by-session outcome measures, and therefore the last-observed measure was carried forward to evaluate the final treatment outcome for all cases irrespective of whether they completed their agreed intervention or dropped out of care. Pseudonymised identifiers were available for all participating services to control for systematic differences in treatment outcomes across treatment sites. The dataset of eligible cases that met the above criteria included records for N = 2064 patients treated across 16 services.

Caseload size across services ranged from 48 to 281; mean = 129.00 (SD = 62.30). In the full sample, the mean age was 39.13 (SD = 13.02), 60.2% were females, and 81.3% were from a White British background (Black = 8.2%, South Asian = 6.3%, multi-racial = 2.5%, Chinese = 0.2, other = 1.4). Approximately 37.9% were unemployed. Mean (SD) baseline psychometric scores were IES-R = 60.61 (16.88), PHQ-9 = 17.48 (5.73), GAD-7 = 15.62 (4.50), WSAS = 22.86 (10.01). Analysis of the primary outcome measure indicated that 93.3% of patients had PTSD severity in the clinical range (IES-R ≥ 33) at the time of intake assessment. In addition, 90.3% had comorbid case-level depression (PHQ-9 ≥ 10) and 93.2% had comorbid anxiety (GAD-7 ≥ 8) symptoms. A breakdown of sample characteristics per each service is available in Supplemental Materials.

2.4. Statistical analysis

2.4.1. Treatment outcomes

Treatment outcomes were summarised in two ways. First, pre–post treatment (within group) effect sizes were calculated across all available measures following guidance by Minami et al. (2008). Next, the proportion of cases that attained full remission of PTSD symptoms was calculated, based on the concept of reliable and clinically significant improvement (RCSI) proposed by Jacobson and Truax (1992). To be classed as RCSI, a patient who had case-level PTSD symptoms (IES-R ≥ 33) at intake: [1] improved by a magnitude greater or equal to the reliable change index (≥9 points), and [2] had sub-clinical symptoms (IES-R < 33) at the last observed treatment appointment. Missing post-treatment IES-R measures were dealt with using multiple imputation by chained equations, leveraging information from available secondary measures.

2.5. Associations between neighbourhood deprivation and PTSD

First, we examined the distribution of PTSD cases across IMD decile groups statistically using a one-sample Wald test. Next, mean levels of baseline IES-R severity across IMD decile groups were plotted on a graph and a non-parametric correlation was calculated, treating IMD as an ordinal variable based on graphical evidence of linear associations.

Next, we used multilevel modelling (MLM) to examine associations between IMD and post-treatment IES-R scores, controlling for systematic variability between services, and adjusting for intake IES-R and PHQ-9 severity. Given the strong correlations between IES-R and GAD-7, and the use of GAD-7 to impute missing IES-R data points, the GAD-7 was not included in the regression model to reduce multicollinearity and to improve model fit. The model structure included patient-level data (level 1) nested within services (level 2), including random intercepts for the service level. Following conventional model-building guidelines (Raudenbush, 2002), continuous predictors were grand mean-centred and MLM was performed in iterative steps, starting with single-level models and eventually fitting multi-level and covariate-adjusted models that optimised goodness-of-fit. Model fit was examined after each modelling step, using the −2 loglikelihood ratio, BIC and AIC indices. The intracluster correlation coefficient (ICC) was calculated to estimate the proportion of variance attributable to the service-level.

Sensitivity analyses repeated the above MLM entering additional variables sequentially in two steps. The first step added employment status and ethnicity as potential confounders. The second step added a main effect for the number of attended therapy sessions and an interaction between IMD and sessions (a moderator analysis). Finally, we graphically examined mean post-treatment IES-R severity and the percentage of patients attaining RCSI across all IMD deciles. Analyses were conducted using IBM SPSS version 29.

3. Results

3.1. Treatment outcomes

Large pre–post treatment effect sizes were observed across all available symptom domains, including PTSD (d = 1.48; 95% CI 1.40–1.55), depression (d = 1.14; 1.07–1.21), and anxiety (d = 1.29; 1.22–1.36). A moderate effect size was observed in the measure of work and social adjustment (d = 0.70; 0.64–0.77). Of those who had case-level PTSD symptoms at intake (N = 1926), 48.1% met criteria for RCSI at the end of their treatment episode.

3.2. Associations between neighbourhood deprivation and PTSD

As shown in Figure 1, the density of PTSD cases across IMD deciles was skewed towards more socioeconomically deprived neighbourhoods, with more than three times more cases (33.6% vs. 9.7%) clustered within the most deprived quintile compared to the least deprived quintile. Results of the Wald test indicated that the distribution of PTSD cases across IMD deciles is not even (Wald Z = −99.03, SE = .01, p < .001). Figure 2 shows a clearly linear and inverse relationship between IMD and IES-R baseline severity (r = −0.16, p < .001), indicating that patients living in the most deprived neighbourhoods (lower IMD decile) also had more severe PTSD symptoms at the start of treatment.

Figure 1.

Figure 1.

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Distribution of treatment-seeking PTSD cases according to socioeconomic deprivation.

Figure 2.

Figure 2.

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Associations between baseline (pre-treatment) PTSD symptom severity and socioeconomic deprivation.

The fully adjusted MLM analysis is displayed in Table 1. All fixed effects in the model were statistically significant (p < .001) and together explained 16.2% of variance in PTSD treatment outcomes. The negative regression coefficient for IMD (B = −0.74) indicates an inverse association, such that lower than average IMD deciles (i.e. more socioeconomically deprived) were associated with higher PTSD severity at the end of treatment. Positive coefficients for the other two variables in the model indicate that higher baseline depression and PTSD symptom severity was associated with higher post-treatment PTSD severity. The model also indicated systematic variability in PTSD treatment outcomes between services, as the random effect explained approximately 2.3% of variance (ICC = .023).

Table 1.

Main effects of fully-adjusted multilevel model predicting post-treatment PTSD severity.

Fixed effects
Variables B SE t p CI-low Ci-high  
Intercept 35.256 1.013 34.801 <.001 33.270 37.243  
Baseline IES-R (mc) 0.413 0.032 12.780 <.001 0.349 0.476  
Baseline PHQ-9 (mc) 0.723 0.096 7.561 <.001 0.536 0.911  
IMD decile (mc) −0.739 0.205 −3.600 <.001 −1.142 −0.336  
Covariance parameters
Effects Variance SE Z p CI-low Ci-high ICC
Residual effect 506.127 15.824 31.984 <.001 476.043 538.112  -
Random effect (services) 11.669 5.826 2.003 .045 4.386 31.047 0.023
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Note. B = regression coefficient; SE = standard error; CI = 95% confidence intervals; mc = mean centred; PTSD = post-traumatic stress disorder; IES-R = revised impact of event scale (PTSD severity); PHQ-9 = patient health questionnaire (depression severity); IMD = index of multiple deprivation (deciles, where 1 = most deprived neighbourhoods); ICC = intracluster correlation coefficient; −2 log likelihood = 18734.034; Akaike information criterion (AIC) = 18738.039; Bayesian information criterion (BIC) = 18749.295; marginal R-square (variance explained by fixed effects) = .162.

Figure 3 illustrates these results graphically, showing that patients living in the least deprived neighbourhoods (IMD deciles ≥5) tended to have mean levels of post-treatment PTSD symptoms in the sub-clinical range (below the cut-off of 33) and higher rates of RCSI compared to those in the most deprived neighbourhoods. Comparisons between the most and least deprived groups show a mean difference of 9.2 points in the IES-R scale (equivalent to a between-groups effect size of d = .39) and a difference of 15.6% in RCSI rates.

Figure 3.

Figure 3.

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Associations between post-treatment PTSD outcomes and socioeconomic deprivation.

The same pattern of results was observed in the first step of the sensitivity analysis, where the effect of IMD remained statistically significant (B = −0.40, SE = 0.21, p = .049) after controlling for employment status and ethnicity. The second step and fully adjusted sensitivity analysis is presented in Table 2. In this model, IMD is no longer statistically significant (B = −0.29, SE = 0.20, p < .156) after including regression terms for treatment sessions and an IMD-by-sessions interaction, both of which were statistically significant (p < .01). In this model, being unemployed was significantly associated with poorer treatment outcomes, but being from an ethnic minority was not.

Table 2.

Sensitivity analysis.

Fixed effects
Variables B SE t p CI-low Ci-high  
Intercept 31.372 1.2089 25.950 <.001 29.001 33.743 31.372
Baseline IES-R (mc) .383 .0311 12.308 <.001 .322 .444 .383
Baseline PHQ-9 (mc) .586 .0936 6.266 <.001 .403 .770 .586
IMD decile (mc) −.286 .2016 −1.419 .156 −.681 .109 −.286
Unemployed 8.671 1.0552 8.217 <.001 6.601 10.740 8.671
Minority ethnic group 2.532 1.3611 1.860 .063 −.138 5.201 2.532
Sessions (mc) −.717 .0676 −10.608 <.001 −.850 −.585 −.717
IMD * sessions (interaction) .075 .0236 3.177 .002 .029 .121 .075
Covariance parameters
Effects Variance SE Z p CI-low Ci-high ICC
Residual effect 461.751 14.451 31.954 <.001 434.279 490.960 -
Random effect (services) 15.553 7.067 2.201 .028 6.384 37.896 0.033
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Note. B = regression coefficient; SE = standard error; CI = 95% confidence intervals; mc = mean centred; PTSD = post-traumatic stress disorder; IES-R = revised impact of events scale (PTSD severity); PHQ-9 = patient health questionnaire (depression severity); IMD = index of multiple deprivation (deciles, where 1 = most deprived neighbourhoods); ICC = intracluster correlation coefficient; −2 log likelihood = 18550.079; Akaike information criterion (AIC) = 18554.084; Bayesian information criterion (BIC) = 18565.336; marginal R-square (variance explained by fixed effects) = .236.

4. Discussion

This study aimed to examine associations between socioeconomic deprivation and PTSD symptom severity before and after exposure to psychological therapy. Consistent with our first hypothesis, the findings indicate that treatment-seeking patients with PTSD in England are more likely to live in socioeconomically deprived neighbourhoods. This is in line with previous research in England demonstrating that more deprived areas have a greater need for psychological therapies for depression and anxiety (Delgadillo et al., 2016) and epidemiological research showing that lower socioeconomic status increases the risk of developing PTSD (Tang et al., 2017). However, it should be noted that this study did not examine the deprivation rates in the PTSD treatment-seeking sample in comparison to the deprivation spread for the service geographical catchment areas as whole.

In line with our second hypothesis, those from more deprived areas started therapy with more severe PTSD symptoms. This is in contrast to findings from a single-city sample from a similar treatment setting, which showed no such association (Richardson et al., 2025). This may be because of the larger sample size and greater geographical spread with more socioeconomic variability in the current sample. The current findings converge with epidemiological research showing that lower income is associated with more severe PTSD symptoms following traumatic incidents (Shiga et al., 2021).

The results show that patients living in more deprived areas experienced less of a reduction in PTSD symptom severity after treatment, supporting our third hypothesis. In the current sample there was considerable variation in recovery rates based on deprivation. This held after adjusting for differences between services, baseline severity of PTSD, comorbid depression symptoms, employment status and ethnicity. Thus, poorer treatment outcomes in patients from deprived areas are not merely explained by higher baseline severity, and are not confounded by ethnic diversity. This is consistent with a previous study showing smaller reduction in PTSD symptoms after treatment for those living in more deprived areas (Richardson et al., 2025), and with a previous analysis of depression and anxiety symptoms in NHS talking therapies (Finegan et al., 2020). Unemployment was also found to be an independent predictor of poorer outcomes from trauma-focused therapy, in line with a previous meta-analysis of outcomes for outcomes from EMDR specifically (Wright et al., 2024). Moreover, sensitivity analyses indicate that the number of therapy sessions moderates the relationship between socioeconomic deprivation and treatment outcomes. In other words, patients living in deprived neighbourhoods generally have poorer treatment outcomes, unless they receive longer treatments – in which case outcomes improve. We note that a small proportion (∼2%) of variance in treatment outcomes was explained by differences between services. It is plausible that these differences are explained by systematic differences in treatment duration policies applied in different services, as evidenced by the wide variability in the mean number of treatment sessions across services (see Supplemental Appendix) ranging from 7.81 to 15.27.

The exact mechanisms for this relationship are unclear. It is unlikely that this association may be explained by treatment dropout, since meta-analytic evidence examining associations between socioeconomic deprivation and dropout does not indicate a statistically significant relationship (Firth et al., 2022). This relationship is not confounded by ethnic diversity either, so cultural adaptations to therapy may not necessarily improve outcomes for patients living in socioeconomically deprived neighbourhoods. It may be that residents of poorer neighbourhoods live in high crime areas and are therefore more likely to be exposed to traumatic incidents such as violence. In London, for example, the poorest 10% of areas has more than double the rates of robbery, violent and sexual crimes than the richest 10% (Trust for London, 2023), and research has shown that lower parental education increases the risk of exposure to childhood sexual abuse (Martin et al., 2011). This may explain the observation that many PTSD treatment-seeking patients live in the most deprived neighbourhoods and experience severe symptoms prior to starting treatment. Richardson et al. (2025) have discussed the possibility that residents of deprived areas could be exposed to recurring threats (e.g. antisocial behaviour, crime) and may not feel safe during therapy, thus requiring longer treatments to gain trust in the therapist and the therapy process.

4.1. Strengths and limitations

This naturalistic cohort study included psychometrically validated outcome measures for over 2000 patients treated across geographically and socioeconomically diverse areas in England. Patients included in the sample lived in neighbourhoods that represented all gradients of socioeconomic deprivation, with large sample sizes in each decile group, enabling the investigation of deprivation-outcome associations with adequate statistical power. Furthermore, the proportion of patients from ethnic minorities in this sample (18.7%) is consistent with general population norms in England (Office of National Statistics, 2022).

A limitation of the current study is that the diagnosis of PTSD for patients treated in this setting was not formally derived from structured diagnostic interviews, and hence there is some uncertainty about the precision of the sample selection. Nevertheless, the IES-R measure applied to establish case-level symptoms has been found to be a reliable case-finding tool for PTSD. Data on the specific treatment that patients were referred to after assessments (CBT or EMDR) were not available for analysis, although the majority would have been offered CBT as this is a commonly available first line intervention in this setting (Clark, 2011). Hence, we were unable to carry out treatment-specific analyses. Moreover, more detailed socioeconomic indicators such as income or education level were not available.

Future research is necessary to understand why patients living in socioeconomically deprived neighbourhoods benefit less from evidence-based trauma-focused therapies, and what adaptations could help to rectify this disparity – aside from lengthier interventions which result in better outcomes. For example, referring to money and debt advice organisations could be helpful: The Money and Mental Health Policy Institute has called for close integration between NHS Talking Therapies and money advice during the cost of living crisis (Bond, 2023).

Overall, the present study provides evidence that socioeconomic deprivation is associated with more severe PTSD symptoms and poorer treatment response, although longer treatments could help to improve clinical outcomes.

Conflicts of interest

TR wrote and receives royalties for the use of ‘Space from Money Worries’ an online CBT package developed by Silvercloud health designed to tackle the link between financial difficulties and mental health problems which is used in NHS Talking Therapies Services. TR is an advisor and shareholder for a company (TellJo) which identifies and supports those with financial vulnerability. JD has no conflicts of interest to declare.

Data sharing policy

In line with the requirements of the ethics review board for this study, requests for access to data are to be made in writing to the corresponding author.

Supplementary Material

Supplemental_materials_v1.docx
ZEPT_A_2547549_SM5335.docx (75.9KB, docx)

Footnotes

1

NHS talking therapies services for anxiety and depression is the current designation of the national treatment system formerly known as Improving Access to Psychological Therapies (IAPT).

Supplemental Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/20008066.2025.2547549.

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