OBJECTIVE Treatment outcomes are known to vary according to therapist and clinic/organization (therapist effect, clinic effect). Outcomes may also vary according to the neighborhood where a person lives (neighborhood effect), but this has not previously been formally quantified. Evidence suggests that deprivation may contribute to explaining such cluster effects. This study aimed to (a) simultaneously quantify neighborhood, clinic, and therapist effects on intervention effectiveness and (b) determine the extent to which deprivation variables explain neighborhood and clinic effects. METHOD The study used a retrospective, observational cohort design with a high intensity psychological intervention sample (N = 617,375), and a low intensity (LI) psychological intervention sample (N = 773,675). Samples each included 55 clinics, 9,000-10,000 therapists/practitioners, and over 18,000 neighborhoods in England. Outcomes were postintervention depression and anxiety scores and clinical recovery. Deprivation variables included individual employment status, domains of neighborhood deprivation, and clinic-level mean deprivation. Data were analyzed using cross-classified multilevel models. RESULTS Unadjusted neighborhood effects of 1%-2% and unadjusted clinic effects of 2%-5% were detected, with proportionally larger effects for LI interventions. After controlling for predictors, adjusted neighborhood effects of 0.0%-0.1% and clinic effects of 1%-2% remained. Deprivation variables were able to explain a significant proportion of the neighborhood effect (80%-90% of neighborhood variance) but not clinic effect. The majority of neighborhood variance could only be explained by a shared effect of baseline severity and socioeconomic deprivation variables. CONCLUSIONS People in different neighborhoods respond differently to psychological intervention, and this clustering effect was mainly explained by socioeconomic factors. People also respond differently according to the clinic they access, but this could not be completely explained by deprivation in the present study. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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社会经济剥夺在解释邻里和诊所对心理干预有效性的影响中的作用。

目标 众所周知，治疗结果因治疗师和诊所/组织（治疗师效果、临床效果）而异。结果也可能因一个人居住的社区而异（邻里效应），但这以前没有被正式量化过。有证据表明，剥夺可能有助于解释这种集群效应。本研究旨在 (a) 同时量化邻里、诊所和治疗师对干预效果的影响，以及 (b) 确定剥夺变量解释邻里和诊所影响的程度。方法 该研究采用回顾性、观察性队列设计，包括高强度心理干预样本 (N = 617,375) 和低强度 (LI) 心理干预样本 (N = 773,675)。每个样本包括 55 个诊所，9,000-10 个，000 名治疗师/从业者，以及英格兰超过 18,000 个社区。结果是干预后抑郁和焦虑评分以及临床康复。剥夺变量包括个人就业状况、邻里剥夺领域和诊所级平均剥夺。使用交叉分类的多层次模型分析数据。结果 检测到 1%-2% 的未调整邻里效应和 2%-5% 的未调整临床效应，LI 干预的影响比例更大。控制预测因素后，调整后的邻里效应为 0.0%-0.1%，临床效应为 1%-2%。剥夺变量能够解释很大一部分邻里效应（邻里差异的 80%-90%），但不能解释临床效应。大多数邻里差异只能用基线严重性和社会经济剥夺变量的共同影响来解释。结论 不同社区的人们对心理干预的反应不同，这种聚集效应主要由社会经济因素解释。人们也会根据他们访问的诊所做出不同的反应，但这不能完全用本研究中的剥夺来解释。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。但这不能完全用本研究中的剥夺来解释。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。但这不能完全用本研究中的剥夺来解释。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。