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Environmental changes were separated into two major groups, positive or negative, determined by patient opinion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In all analyses positive changes were found to be associated with better outcome at 12\u00a0years with respect to accommodation (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.009), relationships (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009007), and substance misuse (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.003), with fewer psychiatric admissions (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.011) and fewer social work contacts at 30\u00a0years (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.043). Using a consolidated outcome measure positive changes were more likely than negative ones to be associated with a good outcome at 12 and 30\u00a0years (39% v 3.6% and 30.2% v 9.1%, respectively). Those with personality disorder at baseline had fewer positive changes (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.018) than others at 12\u00a0years and fewer positive occupational changes at 30\u00a0years (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.041). Service use was greatly reduced in those with positive events with 50\u201380% more time free of all psychotropic drug treatment (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Instrumental positive change had greater effects than imposed changes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Positive environmental change has a favourable impact on clinical outcome in common mental disorders. Although studied naturalistically in this study the findings suggest that if harnessed as a therapeutic intervention, as in nidotherapy and social prescribing, it would yield therapeutic dividends.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00127-023-02520-1","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T09:05:00Z","timestamp":1688979900000},"page":"1587-1598","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The effect of environmental change, planned and unplanned life events on the long-term outcome of common mental disorders"],"prefix":"10.1007","volume":"59","author":[{"given":"Peter","family":"Tyrer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Conor","family":"Duggan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Tyrer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,7,10]]},"reference":[{"key":"2520_CR1","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1146\/annurev.psych.48.1.191","volume":"48","author":"RC Kessler","year":"1997","unstructured":"Kessler RC (1997) The effects of stressful life events on depression. 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