What treatment outcomes matter in adolescent depression? A Q-study of priority profiles among mental health practitioners in the UK and Chile.
Adolescents
Clinician perceptions
Cross-cultural research
Depression
Outcome priorities
Psychotherapy outcome research
Q-methodology
Q-study
Journal
European child & adolescent psychiatry
ISSN: 1435-165X
Titre abrégé: Eur Child Adolesc Psychiatry
Pays: Germany
ID NLM: 9212296
Informations de publication
Date de publication:
31 Jan 2023
31 Jan 2023
Historique:
received:
23
05
2022
accepted:
05
01
2023
entrez:
31
1
2023
pubmed:
1
2
2023
medline:
1
2
2023
Statut:
aheadofprint
Résumé
Evidence-based and person-centred care requires the measurement of treatment outcomes that matter to youth and mental health practitioners. Priorities, however, may vary not just between but also within stakeholder groups. This study used Q-methodology to explore differences in outcome priorities among mental health practitioners from two countries in relation to youth depression. Practitioners from the United Kingdom (UK) (n = 27) and Chile (n = 15) sorted 35 outcome descriptions by importance and completed brief semi-structured interviews about their sorting rationale. By-person principal component analysis (PCA) served to identify distinct priority profiles within each country sample; second-order PCA examined whether these profiles could be further reduced into cross-cultural "super profiles". We identified three UK outcome priority profiles (Reduced symptoms and enhanced well-being; improved individual coping and self-management; improved family coping and support), and two Chilean profiles (Strengthened identity and enhanced insight; symptom reduction and self-management). These could be further reduced into two cross-cultural super profiles: one prioritized outcomes related to reduced depressive symptoms and enhanced well-being; the other prioritized outcomes related to improved resilience resources within youth and families. A practitioner focus on symptom reduction aligns with a long-standing focus on symptomatic change in youth depression treatment studies, and with recent measurement recommendations. Less data and guidance are available to those practitioners who prioritize resilience outcomes. To raise the chances that such practitioners will engage in evidence-based practice and measurement-based care, measurement guidance for a broader set of outcomes may be needed.
Identifiants
pubmed: 36719524
doi: 10.1007/s00787-023-02140-9
pii: 10.1007/s00787-023-02140-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Consejo Nacional de Innovación, Ciencia y Tecnología
ID : REDI170453
Organisme : University College London & Anna Freud National Centre for Children and Families
ID : Impact Studentship
Informations de copyright
© 2023. The Author(s).
Références
Avenevoli S, Swendsen J, He J-P et al (2015) Major depression in the national comorbidity survey-adolescent supplement: prevalence, correlates, and treatment. J Am Acad Child Adolesc Psychiatry 54:37-44.e2. https://doi.org/10.1016/j.jaac.2014.10.010
doi: 10.1016/j.jaac.2014.10.010
Jonsson U, Bohman H, von Knorring L et al (2011) Mental health outcome of long-term and episodic adolescent depression: 15 year follow-up of a community sample. J Affect Disord 130:395–404. https://doi.org/10.1016/j.jad.2010.10.046
doi: 10.1016/j.jad.2010.10.046
Patton GC, Coffey C, Romaniuk H et al (2014) The prognosis of common mental disorders in adolescents: a 14 year prospective cohort study. Lancet 383:1404–1411. https://doi.org/10.1016/S0140-6736(13)62116-9
doi: 10.1016/S0140-6736(13)62116-9
Kovacs M, Obrosky S, George C (2016) The course of major depressive disorder from childhood to young adulthood: recovery and recurrence in a longitudinal observational study. J Affect Disord 203:374–381
doi: 10.1016/j.jad.2016.05.042
Clayborne ZM, Varin M, Colman I (2019) Systematic review and meta-analysis: adolescent depression and long-term psychosocial outcomes. J Am Acad Child Adolesc Psychiatry 58:72–79. https://doi.org/10.1016/j.jaac.2018.07.896
doi: 10.1016/j.jaac.2018.07.896
Bear HA, Edbrooke-Childs J, Norton S et al (2020) Systematic review and meta-analysis: outcomes of routine specialist mental health care for young people with depression and/or anxiety. J Am Acad Child Adolesc Psychiatry 59:810–841. https://doi.org/10.1016/j.jaac.2019.12.002
doi: 10.1016/j.jaac.2019.12.002
Cuijpers P, Karyotaki E, Ciharova M et al (2021) The effects of psychological treatments of depression in children and adolescents on response, reliable change, and deterioration: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry. https://doi.org/10.1007/s00787-021-01884-6
doi: 10.1007/s00787-021-01884-6
Sackett DL, Rosenberg WMC, Gray JAM et al (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312:71–72. https://doi.org/10.1136/bmj.312.7023.71
doi: 10.1136/bmj.312.7023.71
Lambert MJ, Whipple JL, Kleinstäuber M (2018) Collecting and delivering progress feedback: a meta-analysis of routine outcome monitoring. Psychotherapy 55:520–537. https://doi.org/10.1037/pst0000167
doi: 10.1037/pst0000167
Delgadillo J, de Jong K, Lucock M et al (2018) Feedback-informed treatment versus usual psychological treatment for depression and anxiety: a multisite, open-label, cluster randomised controlled trial. Lancet Psychiatry 5:564–572. https://doi.org/10.1016/S2215-0366(18)30162-7
doi: 10.1016/S2215-0366(18)30162-7
Fortney JC, Unützer J, Wrenn G et al (2017) A tipping point for measurement-based care. Psychiatr Serv 68:179–188. https://doi.org/10.1176/appi.ps.201500439
doi: 10.1176/appi.ps.201500439
Kitson A, Marshall A, Bassett K, Zeitz K (2013) What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. J Adv Nurs 69:4–15. https://doi.org/10.1111/j.1365-2648.2012.06064.x
doi: 10.1111/j.1365-2648.2012.06064.x
Santana MJ, Manalili K, Jolley RJ et al (2018) How to practice person-centred care: a conceptual framework. Heal Expect 21:429–440. https://doi.org/10.1111/hex.12640
doi: 10.1111/hex.12640
Haynes RB, Devereaux PJ, Guyatt GH (2002) Clinical expertise in the era of evidence-based medicine and patient choice. Evid Based Med 7:36–38. https://doi.org/10.1136/ebm.7.2.36
doi: 10.1136/ebm.7.2.36
Lewis CC, Boyd M, Puspitasari A et al (2019) Implementing measurement-based care in behavioral health. JAMA Psychiat 76:324. https://doi.org/10.1001/jamapsychiatry.2018.3329
doi: 10.1001/jamapsychiatry.2018.3329
Harmon SC, Lambert MJ, Smart DM et al (2007) Enhancing outcome for potential treatment failures: therapist-client feedback and clinical support tools. Psychother Res 17:379–392. https://doi.org/10.1080/10503300600702331
doi: 10.1080/10503300600702331
Reese RJ, Norsworthy LA, Rowlands SR (2009) Does a continuous feedback system improve psychotherapy outcome? Psychotherapy 46:418–431. https://doi.org/10.1037/a0017901
doi: 10.1037/a0017901
Simon W, Lambert MJ, Harris MW et al (2012) Providing patient progress information and clinical support tools to therapists: Effects on patients at risk of treatment failure. Psychother Res 22:638–647. https://doi.org/10.1080/10503307.2012.698918
doi: 10.1080/10503307.2012.698918
Knaup C, Koesters M, Schoefer D et al (2009) Effect of feedback of treatment outcome in specialist mental healthcare: meta-analysis. Br J Psychiatry 195:15–22. https://doi.org/10.1192/bjp.bp.108.053967
doi: 10.1192/bjp.bp.108.053967
Zhu M, Hong RH, Yang T et al (2021) The efficacy of measurement-based care for depressive disorders. J Clin Psychiatry 82:138–175. https://doi.org/10.4088/JCP.21r14034
doi: 10.4088/JCP.21r14034
Hanna B, Hege K, Adriani N et al (2018) Client feedback in psychological therapy for children and adolescents with mental health problems. Cochrane Database Syst Rev 8:CD011729. https://doi.org/10.1002/14651858.CD011729.pub2
doi: 10.1002/14651858.CD011729.pub2
Metz MJ, Veerbeek MA, Twisk JWR et al (2019) Shared decision-making in mental health care using routine outcome monitoring: results of a cluster randomised-controlled trial. Soc Psychiatry Psychiatr Epidemiol 54:209–219. https://doi.org/10.1007/s00127-018-1589-8
doi: 10.1007/s00127-018-1589-8
Simmons MB, Elmes A, McKenzie JE et al (2017) Right choice, right time: evaluation of an online decision aid for youth depression. Heal Expect 20:714–723
doi: 10.1111/hex.12510
Batty MJ, Moldavsky M, Foroushani PS et al (2013) Implementing routine outcome measures in child and adolescent mental health services: from present to future practice. Child Adolesc Ment Health 18:82–87. https://doi.org/10.1111/j.1475-3588.2012.00658.x
doi: 10.1111/j.1475-3588.2012.00658.x
Norman S, Dean S, Hansford L, Ford T (2014) Clinical practitioner’s attitudes towards the use of routine outcome monitoring within child and adolescent mental health services: a qualitative study of two child and adolescent mental health services. Clin Child Psychol Psychiatry 19:576–595. https://doi.org/10.1177/1359104513492348
doi: 10.1177/1359104513492348
Wolpert M, Curtis-Tyler K, Edbrooke-Childs J (2016) A Qualitative exploration of patient and clinician views on patient reported outcome measures in child mental health and diabetes services. Adm Policy Ment Heal Ment Heal Serv Res 43:309–315. https://doi.org/10.1007/s10488-014-0586-9
doi: 10.1007/s10488-014-0586-9
Sharples E, Qin C, Goveas V et al (2017) A qualitative exploration of attitudes towards the use of outcome measures in child and adolescent mental health services. Clin Child Psychol Psychiatry 22:219–228. https://doi.org/10.1177/1359104516652929
doi: 10.1177/1359104516652929
Krause KR, Bear HA, Edbrooke-Childs J, Wolpert M (2019) Review: what outcomes count? A review of outcomes measured for adolescent depression between 2007 and 2017. J Am Acad Child Adolesc Psychiatry 58:61–71. https://doi.org/10.1016/j.jaac.2018.07.893
doi: 10.1016/j.jaac.2018.07.893
Mew EJ, Monsour A, Saeed L et al (2020) Systematic scoping review identifies heterogeneity in outcomes measured in adolescent depression clinical trials. J Clin Epidemiol 126:71–79. https://doi.org/10.1016/j.jclinepi.2020.06.013
doi: 10.1016/j.jclinepi.2020.06.013
Cortés AM, Fernández OM, Capella CM et al (2018) What changes in psychotherapy? The perspective of adolescents with depressive symptoms, their therapists, and external observers. Psykhe 27:1–15. https://doi.org/10.7764/psykhe.27.1.1134
doi: 10.7764/psykhe.27.1.1134
Krause KR, Midgley N, Edbrooke-Childs J, Wolpert M (2021) A comprehensive mapping of outcomes following psychotherapy for adolescent depression: the perspectives of young people, their parents and therapists. Eur Child Adolesc Psychiatry 30:1779–1791. https://doi.org/10.1007/s00787-020-01648-8
doi: 10.1007/s00787-020-01648-8
Krause KR, Chung S, Adewuya AO et al (2021) International consensus on a standard set of outcome measures for child and youth anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder. Lancet Psychiatry 8:76–86. https://doi.org/10.1016/S2215-0366(20)30356-4
doi: 10.1016/S2215-0366(20)30356-4
Monga S, Monsour A, Stallwood E et al (2020) Core outcome set development for adolescent major depressive disorder clinical trials: a registered report. J Am Acad Child Adolesc Psychiatry 59:1297–1298. https://doi.org/10.1016/j.jaac.2020.07.905
doi: 10.1016/j.jaac.2020.07.905
Fonagy P (2010) Psychotherapy research: do we know what works for whom? Br J Psychiatry 197:83–85. https://doi.org/10.1192/bjp.bp.110.079657
doi: 10.1192/bjp.bp.110.079657
Strupp HH, Hadley SW (1977) A tripartite model of mental health and therapeutic outcomes. With special reference to negative effects in psychotherapy. Am Psychol 32:187–196
doi: 10.1037/0003-066X.32.3.187
Odhammar F, Carlberg G (2015) Parents’ and psychotherapists’ goals prior to psychodynamic child psychotherapy. Eur J Psychother Couns 17:277–295. https://doi.org/10.1080/13642537.2015.1059865
doi: 10.1080/13642537.2015.1059865
Fonagy P (1997) Evaluating the effectiveness of interventions in child psychiatry. Can J Psychiatry 42:584–594. https://doi.org/10.1177/070674379704200604
doi: 10.1177/070674379704200604
Binder PE, Holgersen H, Nielsen GH (2010) What is a “good outcome” in psychotherapy? A qualitative exploration of former patients’ point of view. Psychother Res 20:285–294. https://doi.org/10.1080/10503300903376338
doi: 10.1080/10503300903376338
Cohen DJ (1995) Psychosocial therapies for children and adolescents: overview and future directions. J Abnorm Child Psychol 23:141–156. https://doi.org/10.1007/BF01447049
doi: 10.1007/BF01447049
Krause KR, Edbrooke-Childs J, Bear HA et al (2021) What treatment outcomes matter most? A Q-study of outcome priority profiles among youth with lived experience of depression. Eur Child Adolesc Psychiatry. https://doi.org/10.1007/s00787-021-01839-x
doi: 10.1007/s00787-021-01839-x
Jackson-Blott DK, Hare DD, Morgan DS, Davies DB (2019) Recovery from psychosis in a forensic service: assessing staff and service users’ perspectives using Q methodology. J Forensic Psychol Res Pract 19:147–169. https://doi.org/10.1080/24732850.2018.1556516
doi: 10.1080/24732850.2018.1556516
Dean R, Siddiqui S, Beesley F et al (2018) Staff perceptions of borderline personality disorder and recovery: a Q-sort method approach. Br J Clin Psychol 57:473–490. https://doi.org/10.1111/bjc.12180
doi: 10.1111/bjc.12180
Brown SR (2006) A match made in heaven: a marginalized methodology for studying the marginalized. Qual Quant 40:361–382. https://doi.org/10.1007/s11135-005-8828-2
doi: 10.1007/s11135-005-8828-2
Stephenson W (1935) Correlating persons in stead of tests. Character Pers 4:17–24
doi: 10.1111/j.1467-6494.1935.tb02022.x
Baker R, Thompson C, Mannion R (2006) Q methodology in health economics. J Heal Serv Res Policy 11:38–45. https://doi.org/10.1258/135581906775094217
doi: 10.1258/135581906775094217
Sadler K, Vizard T, Ford T, et al (2018) Mental Health of Children and Young People in England, 2017: Emotional Disorders—Tables. London
Vicente B, Saldivia S, De La Barra F et al (2012) Prevalence of child and adolescent mental disorders in Chile: a community epidemiological study. J Child Psychol Psychiatry Allied Discip 53:1026–1035. https://doi.org/10.1111/j.1469-7610.2012.02566.x
doi: 10.1111/j.1469-7610.2012.02566.x
Inglehart R, Carballo M (1997) Does latin america exist? (and is there a confucian culture?): a global analysis of cross- cultural differences. Polit Sci Polit 30:34–47
doi: 10.1017/S104909650004261X
Gorsky M (2008) The British national health service 1948–2008: a review of the historiography. Soc Hist Med 21:437–460. https://doi.org/10.1093/shm/hkn064
doi: 10.1093/shm/hkn064
Bossert TJ, Leisewitz T (2016) Innovation and change in the chilean health system. N Engl J Med 374:1–5. https://doi.org/10.1056/NEJMp1514202
doi: 10.1056/NEJMp1514202
Caneo C, Calderón J (2018) Evidence-based practice in Chile. BJPsych International. https://doi.org/10.1192/bji.2017.20
doi: 10.1192/bji.2017.20
The National Institute for Health and Care Excellence [NICE] (2019) Depression in children and young people: identification and management (NICE Guideline No. 134)
Ministerio de Salud de Chile (2013) Guías Clínicas AUGE: Depresión en personas de 15 años y más. MINSAL, Santiago
Opazo R, Bagladi V (2008) Integrative psychotherapy: from chile with love. J Psychother Integr 18:126–135. https://doi.org/10.1037/1053-0479.18.1.126
doi: 10.1037/1053-0479.18.1.126
Watts S, Stenner P (2012) Doing Q methodological research: theory. SAGE Publications Ltd, London, Method and Interpretation
van Exel JA, de Graaf G (2005) Q methodology: A sneak preview
Morse JM (1995) The significance of saturation. Qual Health Res 5:147–149
doi: 10.1177/104973239500500201
Biernacki P, Waldorf D (1981) Snowball sampling: problems and techniques of chain referral sampling. Sociol Methods Res 10:141–163. https://doi.org/10.1177/004912418101000205
doi: 10.1177/004912418101000205
Brislin RW (1970) Back-translation for cross-cultural research. J Cross Cult Psychol 1:185–216
doi: 10.1177/135910457000100301
Gallagher K, Porock D (2010) The use of interviews in Q methodology: card content analysis. Nurs Res 59:295–300. https://doi.org/10.1097/NNR.0b013e3181e4ffff
doi: 10.1097/NNR.0b013e3181e4ffff
Schmolck P (2014) PQMethod (Version 2.35) [Computer Software]
van Exel JA, de Graaf G, Brouwer WBFF (2006) “Everyone dies, so you might as well have fun!” attitudes of dutch youths about their health lifestyle. Soc Sci Med 63:2628–2639. https://doi.org/10.1016/j.socscimed.2006.06.028
doi: 10.1016/j.socscimed.2006.06.028
Elo S, Kyngäs H (2008) The qualitative content analysis process. J Adv Nurs 62:107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
doi: 10.1111/j.1365-2648.2007.04569.x
Kline P (1994) An easy guide to factor analysis. Routledge, London, England
Watts S, Stenner P (2005) The subjective experience of partnership love: a Q Methodological study. Br J Soc Psychol 44:85–107. https://doi.org/10.1348/014466604X23473
doi: 10.1348/014466604X23473
Davidson L, Roe D (2007) Recovery from versus recovery in serious mental illness: one strategy for lessening confusion plaguing recovery. J Ment Heal 16:459–470. https://doi.org/10.1080/09638230701482394
doi: 10.1080/09638230701482394
Leamy M, Bird V, Le Boutillier C et al (2011) Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. Br J Psychiatry 199:445–452. https://doi.org/10.1192/bjp.bp.110.083733
doi: 10.1192/bjp.bp.110.083733
Pilgrim D, McCranie A (2013) Recovery and mental health: a critical sociological account. Palgrave Macmillan, New York, NY
doi: 10.1007/978-1-137-35889-9
Slade M, Amering M, Oades L (2008) Recovery: an international perspective. Epidemiol Psichiatr Soc 17:128–137. https://doi.org/10.1017/S1121189X00002827
doi: 10.1017/S1121189X00002827
Clarke M, Williamson P (2015) Core outcome sets and trial registries. Trials 16:15–17. https://doi.org/10.1186/s13063-015-0738-6
doi: 10.1186/s13063-015-0738-6
Slade M (2017) Implementing shared decision making in routine mental health care. World Psychiatry 16:146–153
doi: 10.1002/wps.20412
Sales CMD, Ashworth M, Ayis S et al (2022) Idiographic patient reported outcome measures (I-PROMs) for routine outcome monitoring in psychological therapies: position paper. J Clin Psychol. https://doi.org/10.1002/jclp.23319
doi: 10.1002/jclp.23319
Osborn TL, Kleinman A, Weisz JR (2020) Complementing standard western measures of depression with locally co-developed instruments: A cross-cultural study on the experience of depression among the Luo in Kenya. Transcult Psychiatry 58(4):499–515. https://doi.org/10.1177/1363461521100055
doi: 10.1177/1363461521100055
Chevance A, Tran VT, Ravaud P (2020) Improving the generalizability and credibility of core outcome sets (COSs) by a large and international participation of diverse stakeholders. J Clin Epidemiol. https://doi.org/10.1016/j.jclinepi.2020.01.004
doi: 10.1016/j.jclinepi.2020.01.004
Brown SR (2005) Applying Q Methodology to Empowerment. In: Narayan D (ed) Measuring empowerment: cross-disciplinary perspectives. The World Bank, Washington, DC, pp 197–215
Danielson S (2009) Q Method and surveys: three ways to combine Q and R. Field Methods 21:219–237. https://doi.org/10.1177/1525822X09332082
doi: 10.1177/1525822X09332082
Akhtar-Danesh N, Baumann A, Cordingley L (2008) Q-methodology in nursing research: a promising method for the study of subjectivity. West J Nurs Res 30:759–773. https://doi.org/10.1177/0193945907312979
doi: 10.1177/0193945907312979
Jensen PS, Hoagwood K, Petti T (1996) Outcomes of mental health care for children and adolescents: II. Literature review and application of a comprehensive model. J Am Acad Child Adolesc Psychiatry 35:1064–1077. https://doi.org/10.1097/00004583-199608000-00018
doi: 10.1097/00004583-199608000-00018
Hoagwood KE, Jensen PS, Acri MC et al (2012) Outcome domains in child mental health research since 1996: Have they changed and why does it matter? J Am Acad Child Adolesc Psychiatry 51:1241–1260. https://doi.org/10.1016/j.jaac.2012.09.004
doi: 10.1016/j.jaac.2012.09.004