Abstract
Strategies for comparing routinely collected outcome data across services or systems include focusing on a common indicator (e.g., symptom change) or aggregating results from different measures or outcomes into a comparable core metric. The implications of either approach for judging treatment success are not fully understood. This study drew on naturalistic outcome data from 1641 adolescents with moderate or severe anxiety and/or depression symptoms who received routine specialist care across 60 mental health services in England. The study compared rates of meaningful improvement between the domains of internalizing symptoms, functioning, and progress towards self-defined goals. Consistent cross-domain improvement was observed in only 15.6% of cases. Close to one in four (24.0%) young people with reliably improved symptoms reported no reliable improvement in functioning. Inversely, one in three (34.8%) young people reported meaningful goal progress but no reliable symptom improvement. Monitoring systems that focus exclusively on symptom change risk over- or under-estimating actual impact, while aggregating different outcomes into a single metric can mask informative differences in the number and type of outcomes showing improvement. A move towards harmonized outcome measurement approaches across multiple domains is needed to ensure fair and meaningful comparisons.
Highlights
Anxiety and depression are among the most common mental health conditions in young people worldwide [1,2,3]
This study examined the convergence of meaningful improvement ratings [46] between (a) two measures of internalizing symptoms; (b) two measures of psychosocial functioning; and (c) between aggregate ratings in the domains of symptoms, functioning, and progress towards self-defined goals in a sample of adolescents aged 12–18 years with moderate or severe depression and/ or anxiety symptoms who accessed routine specialist mental health care
This study was a post-hoc analysis of naturalistic outcome data collected by specialist child and adolescent mental health services in England between 2011 and 2015, and collated by the Child Outcomes Research Consortium (CORC)1 as part of NHS England’s Children and Young People’s Improving Access to Psychological Therapies (CYP IAPT) service transformation initiative [34, 48]
Summary
Anxiety and depression are among the most common mental health conditions in young people worldwide [1,2,3]. Collected outcome data has an important role in enhancing the effectiveness of routine care for adolescent anxiety and depression, by informing adjustments to individual treatment plans, service planning, target setting and comparisons of effectiveness across settings and care models [17,18,19,20]. Services wishing to embed routine outcome monitoring face the challenge of having to identify the most important outcomes to measure, as well as the most suitable measurement instruments to track these outcomes. Such instruments should be feasible, acceptable, valid, and reliable [21]. While standards for the routine measurement of outcomes for adolescent depression are beginning to emerge [21], they are not yet widely implemented
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