A comprehensive mapping of outcomes following psychotherapy for adolescent depression: The perspectives of young people, their parents and therapists

K Krause,N Midgley,M Wolpert,J Edbrooke-Childs

doi:10.1007/s00787-020-01648-8

Abstract

As mental health systems move towards person-centred care, outcome measurement in clinical research and practice should track changes that matter to young people and their families. This study mapped the types of change described by three key stakeholder groups following psychotherapy for depression, and compared the salience of these outcomes with the frequency of their measurement in recent quantitative treatment effectiveness studies for adolescent depression.Using qualitative content analysis, this study identified and categorized outcomes across 102 semi-structured interviews that were conducted with depressed adolescents, their parents, and therapists, as part of a randomized superiority trial. Adolescents had been allocated to Cognitive-Behavioral Therapy, Short-Term Psychoanalytic Psychotherapy, or a Brief Psychosocial Intervention.The study mapped seven high-level outcome domains and 29 outcome categories. On average, participants discussed change in four domains and six outcome categories. The most frequently discussed outcome was an improvement in mood and affect (i.e., core depressive symptoms), but close to half of the participants also described changes in family functioning, coping and resilience, academic functioning, or social functioning. Coping had specific importance for adolescents, while parents and therapists showed particular interest in academic functioning. There was some variation in the outcomes discussed beyond these core themes, across stakeholder groups and treatment arms.Of the outcomes that were frequently discussed in stakeholder narratives, only symptomatic change has been commonly reported in recent treatment studies for adolescent depression. A shift towards considering multiple outcome domains and perspectives is needed to reflect stakeholder priorities and enable more nuanced insights into change processes.

Highlights

Depression is a common mental health problem in adolescence and one of the leading causes of health-related disability amongst young people worldwide [1]
This study aims to address these gaps by providing a systematic mapping of outcomes described by adolescents, parents, and therapists following treatment in three different arms of a psychotherapy trial for adolescent depression
This study highlights that adolescents, parents, and therapists consider a range of outcomes when reflecting on change observed over the course of therapy for depression

Summary

Introduction

Depression is a common mental health problem in adolescence and one of the leading causes of health-related disability amongst young people worldwide [1]. Qualitative research has an important role in providing a deeper understanding of therapy outcome from the perspective of key stakeholder groups [16], which include young people, parents, and therapists. Existing studies exploring their notions of ‘good outcome’ have drawn attention to a broader range of themes, as well as divergent priorities between groups. Most existing qualitative studies have employed heterogeneous samples, including children and adolescents with a range of presenting problems, without disaggregating findings for specific subgroups It remains unclear what outcomes stakeholders value for adolescent depression. The post-treatment perspective has been described as the most informative for investigating outcome perceptions [34]

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