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. 2022 Aug;53(4):737-753.
doi: 10.1007/s10578-021-01149-y. Epub 2021 Apr 7.

Are We Comparing Apples with Oranges? Assessing Improvement Across Symptoms, Functioning, and Goal Progress for Adolescent Anxiety and Depression

Karolin Rose Krause  1   2 , Julian Edbrooke-Childs  3   4 , Rosie Singleton  3   4 , Miranda Wolpert  3   5
Affiliations

Are We Comparing Apples with Oranges? Assessing Improvement Across Symptoms, Functioning, and Goal Progress for Adolescent Anxiety and Depression

Karolin Rose Krause et al. Child Psychiatry Hum Dev. 2022 Aug.

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.

Keywords: Adolescents; Anxiety; Depression; Functioning; Outcome; Personalized measures.

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Conflict of interest statement

KRK was involved in the development of the ICHOM standard set of outcomes for child and youth anxiety and depression and received personal fees from ICHOM during the development of the set (October 2018-March 2020). The ICHOM standard set is available free of charge and there is no financial conflict of interest. KRK is involved in the development of a core outcome set for adolescent depression clinical trials as part of the International Network for Research Outcomes in Adolescent Depression Studies (IN-ROADS) initiative. JEC and MW were involved in the programme of service transformation that generated the data that this manuscript draws on. MW led the outcomes and evaluation group that agreed the approach to measurement used in the initiative. MW is now Head of the new Mental Health Priority Area at the Wellcome Trust, which may be developing core outcome sets in mental health in the future. MW has been involved in the development of the Current View Tool, which is a freely available measure and there is no financial conflict of interest. MW was previously Head of the Child Outcomes Research Consortium (CORC), which advises on measurement in child mental health, and she was an advisor to NHS England on informatics. RS has no conflicts to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of the analytical process and sampling
Fig. 2
Fig. 2
Venn diagram of meaningful improvement.a Across all three outcome domains
See this image and copyright information in PMC

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