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

Publisher: Kluwer Academic/Plenum Publishers Country of Publication: United States NLM ID: 1275332 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1573-3327 (Electronic) Linking ISSN: 0009398X NLM ISO Abbreviation: Child Psychiatry Hum Dev Subsets: MEDLINE

Publication: 1999- : New York : Kluwer Academic/Plenum Publishers
Original Publication: New York, Behavioral Publications

Depression*/diagnosis ; Depression*/therapy ; Goals*; Adolescent ; Anxiety/diagnosis ; Anxiety/therapy ; Anxiety Disorders/diagnosis ; Anxiety Disorders/therapy ; Humans ; Treatment Outcome

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.
(© 2021. The Author(s).)

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

Date Created: 20210407 Date Completed: 20220719 Latest Revision: 20220912

20240104

PMC9287244

10.1007/s10578-021-01149-y

33826029