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McLeod J, Stänicke E, Oddli HW, Smith S, Pearce P, Cooper M. How do we know whether treatment has failed? Paradoxical outcomes in counseling with young people. Front Psychol 2024; 15:1390579. [PMID: 38895499 PMCID: PMC11184953 DOI: 10.3389/fpsyg.2024.1390579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/02/2024] [Indexed: 06/21/2024] Open
Abstract
Background In both routine practice contexts and research studies, evidence from standardized self-report symptom measures, administered pre- and post-treatment, is predominantly used to determine whether psychotherapy has been successful. Understanding the nature of unsuccessful psychotherapy requires an ability to evaluate the credibility of outcome data generated by such techniques. An important body of research has identified discrepancies between outcomes assessed through symptom measures and those obtained from other sources. However, not enough is known about the extent to which such paradoxical outcomes exist. Objective This study analyzes the relationship between outcomes, as assessed by a standardized self-report measure, and as assessed by ratings of young people's descriptions of change at post-counseling interviews. Methods Participants were 50 young people (13-16 years old) who had taken part in a trial of up to 10 weeks of school-based humanistic counseling. Our primary standardized measure was the Young Person's CORE (YP-CORE). To assess young people's experiences of counseling change, three independent raters scrutinized transcripts of post-counseling interviews, and scored levels of helpfulness on a 1 (Not at all helpful) to 10 (Extremely helpful) scale. Inter-rater reliabilities were 0.94 (Cronbach's Alpha) and 0.96 (McDonald's Omega). Sensitivity analyses were conducted to explore relationships between helpfulness ratings and other outcome measures, i.e., satisfaction with counseling (ESQ) and the Goal-Based-Outcome Tool (GBO), and process measures, i.e., the Working Alliance Inventory (WAI-S) and the Barret Lennard Relationship Inventory (BLRI). Results Multilevel analysis indicated that helpfulness ratings were not significantly associated with changes in YP-CORE scores. Analyzed categorically, 38% of those showing reliable improvement on the standardized measure were below the median for self-described helpfulness, and 47% of those not showing reliable change were at or above the median for self-described helpfulness. Sensitivity analyses demonstrated closer correlations between helpfulness ratings and other outcome measures (ESQ and GBO), and between helpfulness ratings and process measures (WAI-S and BLRI). Discussion Our results raise questions about reliance on symptom change outcome measures for defining treatment success and failure, given their disparity with clients' own descriptions of the helpfulness of therapy. Implications for practice and research are discussed.
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Affiliation(s)
- John McLeod
- Institute for Integrative Counselling and Psychotherapy, Dublin, Ireland
| | - Erik Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Stephanie Smith
- Research and Policy, National Children’s Bureau, London, United Kingdom
| | - Peter Pearce
- Faculty of Applied Social and Organisational Sciences, Metanoia Institute, London, United Kingdom
| | - Mick Cooper
- School of Psychology, University of Roehampton, Roehampton, United Kingdom
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Gan X, Li X, Cai Y, Yin B, Pan Q, Teng T, He Y, Tang H, Wang T, Li J, Zhu Z, Zhou X, Li J. Metabolic features of adolescent major depressive disorder: A comparative study between treatment-resistant depression and first-episode drug-naive depression. Psychoneuroendocrinology 2024; 167:107086. [PMID: 38824765 DOI: 10.1016/j.psyneuen.2024.107086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/12/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024]
Abstract
Major depressive disorder (MDD) is a psychiatric illness that can jeopardize the normal growth and development of adolescents. Approximately 40% of adolescent patients with MDD exhibit resistance to conventional antidepressants, leading to the development of Treatment-Resistant Depression (TRD). TRD is associated with severe impairments in social functioning and learning ability and an elevated risk of suicide, thereby imposing an additional societal burden. In this study, we conducted plasma metabolomic analysis on 53 adolescents diagnosed with first-episode drug-naïve MDD (FEDN-MDD), 53 adolescents with TRD, and 56 healthy controls (HCs) using hydrophilic interaction liquid chromatography-mass spectrometry (HILIC-MS) and reversed-phase liquid chromatography-mass spectrometry (RPLC-MS). We established a diagnostic model by identifying differentially expressed metabolites and applying cluster analysis, metabolic pathway analysis, and multivariate linear support vector machine (SVM) algorithms. Our findings suggest that adolescent TRD shares similarities with FEDN-MDD in five amino acid metabolic pathways and exhibits distinct metabolic characteristics, particularly tyrosine and glycerophospholipid metabolism. Furthermore, through multivariate receiver operating characteristic (ROC) analysis, we optimized the area under the curve (AUC) and achieved the highest predictive accuracy, obtaining an AUC of 0.903 when comparing FEDN-MDD patients with HCs and an AUC of 0.968 when comparing TRD patients with HCs. This study provides new evidence for the identification of adolescent TRD and sheds light on different pathophysiologies by delineating the distinct plasma metabolic profiles of adolescent TRD and FEDN-MDD.
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Affiliation(s)
- Xieyu Gan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuping Cai
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai, China
| | - Bangmin Yin
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiyuan Pan
- The First People's Hospital of Zaoyang City, Hubei, China
| | - Teng Teng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuqian He
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Han Tang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Wang
- Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengjiang Zhu
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai, China; Shanghai Key Laboratory of Aging Studies, Shanghai, China.
| | - Xinyu Zhou
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Jinfang Li
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Rivera Nales CJ, Triplett NS, Woodard GS, Meza R, Valdivieso A, Goel V, Dorsey S, Berliner L, Martin P. CBT+ Training Initiative in Washington State Community Mental Health: An Evaluation of Child Clinical Outcomes. Community Ment Health J 2024; 60:649-661. [PMID: 37880492 DOI: 10.1007/s10597-023-01194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 09/23/2023] [Indexed: 10/27/2023]
Abstract
The Washington State CBT+ Initiative offers a flexible training and consultation approach for community mental health providers in evidence-based practices for four child mental health targets: cognitive behavioral therapy for depression, anxiety, trauma, and behavioral difficulties. As part of consultation, clinicians used an online system to track delivery of treatment components and clinical outcomes using standardized symptom measures. The current study used these clinician-input data to examine symptom change for children using paired sample t-tests. Additionally, we explored if time elapsed or number of sessions between measurements related to symptom change using simple linear regression. Children had significant symptom reduction across all four targets. For most measures, children did not show greater improvements with increased length of time or increased number of sessions between assessment measures. Findings suggest that children treated by a CBT+ trained clinician may demonstrate symptom reduction for their primary clinical problem. Findings add to support for flexible training approaches for community mental health clinicians.
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Affiliation(s)
- Cristian J Rivera Nales
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Noah S Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Grace S Woodard
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Rosemary Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Alejandro Valdivieso
- Department of Clinical and Counseling Psychology, Columbia University, New York, NY, USA
| | - Vanshika Goel
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Prerna Martin
- Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA
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Redburn J, Hayes B. Facilitators and barriers to "Positive Outcomes" from cognitive-behavioral therapy, according to young people: A thematic synthesis. J Clin Psychol 2024; 80:968-1002. [PMID: 38328892 DOI: 10.1002/jclp.23653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/18/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This qualitative review sought to explore how young people (YP) conceptualize positive outcomes from cognitive-behavioral therapy (CBT) and what YP perceive to be the facilitators and barriers to positive outcomes. METHODS A systematic literature search was conducted in June 2021 using six online databases. Studies were included if qualitative data were collected from participants who were aged up to 25, had internalizing mental health difficulties, and had received in-person CBT from trained practitioners. RESULTS Nineteen studies were included. The Gough Weight of Evidence framework was used to assess methodological and topical quality and relevance. A thematic synthesis identified 34 conceptualizations of positive outcomes, 57 facilitators, and 49 barriers. Descriptive and analytical themes were identified. In line with the review's pragmatic perspective, the latter were worded as practice recommendations: acknowledge YP's perspectives on outcomes, teach tangible CBT techniques, balance autonomy and support, frame CBT as "upskilling," explore nuanced barriers to engagement, and consider the power of group dynamics. CONCLUSIONS This review established the range of YP's views about positive outcomes from CBT, as well as facilitators and barriers to achieving these. Findings should prompt CBT practitioners to reflect and consider how their practice might be shaped through reports from YP as experts by experience.
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Affiliation(s)
- James Redburn
- Clinical Educational and Health Psychology, University College London, London, UK
| | - Ben Hayes
- Clinical Educational and Health Psychology, University College London, London, UK
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Fang G, Wang Y, Yuan H, Yan N, Zhi S. Unraveling the core symptoms of mental health in senior grade three students- a network analysis. Front Psychiatry 2024; 15:1364334. [PMID: 38711876 PMCID: PMC11071079 DOI: 10.3389/fpsyt.2024.1364334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/09/2024] [Indexed: 05/08/2024] Open
Abstract
Background Adolescence is not only an important transitional period of many developmental challenges, but also a high risk period for mental health problems. Psychotherapy is recommended for mental health problems in adolescents, but its effectiveness is not always satisfactory. One possible contributing factor may be the lack of clarity surrounding core symptoms. Methods In this study, we investigated the mental health status of senior grade three students, a group of adolescents facing college entrance exams, by the Middle School Student Mental Health Test (MHT) and analyzed the core symptoms by network analysis. This study was conducted through an online survey platform (www.xiaodongai.com) from 15 February 2023 to 28 March 2024. The subjects scanned a QR code with their mobile phone to receive the questionnaire. Results The mean age of these 625 students were 18.11 ± 2.90 years. There are 238 male participants and 387 female participants. 107 individuals scored above 56 (107/461, 23.2%), with individual scale scores over 8 up to over 60% of participating students. Notably, the top three prominent symptoms were "academic anxiety", "allergic tendency" and "somatic symptoms". However, upon conducting network analysis, it became evident that three strongest edges in this network were "somatic symptoms" and "impulsive tendency", "academic anxiety" and "social anxiety" as well as "social anxiety" and "Loneliness tendency". "somatic symptoms", "social anxiety" and "self-blame tendency" exerted the highest expected influence. This suggests that, statistically speaking, these three symptoms exhibited the strongest interconnections within the network. Limitation Cross-sectional analysis; Bias in self-reported variables. Conclusion These findings can deepen the knowledge of mental health among senior grade three students and provide some implications (i.e., targeting symptoms having highest expected influence) for clinical prevention and intervention to address the mental health needs of this particular group.
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Affiliation(s)
- Guoxiang Fang
- Department of Emergency, Third Hospital of Xi’an, The Affiliated Hospital of Northwest University, Xi’an, Shaanxi, China
| | - Ying Wang
- Department of Psychiatry, Xi’an International Medical Center Hospital, The Affiliated Hospital of Northwest University, Xi’an, Shaanxi, China
| | - Huiling Yuan
- Department of Psychiatry, Xi’an International Medical Center Hospital, The Affiliated Hospital of Northwest University, Xi’an, Shaanxi, China
| | - Ne Yan
- Department of Psychology, Xi’an Physical Education University, Xi’an, Shaanxi, China
| | - Shaomin Zhi
- Department of Emergency, Third Hospital of Xi’an, The Affiliated Hospital of Northwest University, Xi’an, Shaanxi, China
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Ruphrect-Smith H, Davies S, Jacob J, Edbrooke-Childs J. Ethnic differences in treatment outcome for children and young people accessing mental health support. Eur Child Adolesc Psychiatry 2024; 33:1121-1131. [PMID: 37245162 PMCID: PMC11032270 DOI: 10.1007/s00787-023-02233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
Children and Young People (CYP) from minoritized ethnic backgrounds experience structural inequalities in Children and Young People's Mental Health Settings (CYPMHS). This mixed methods study explores whether CYP's ethnicity is associated with their treatment outcomes (operationalised as 'measurable change') from CYPMHS. A multilevel multi-nominal regression analysis, controlling for age, gender, referral source, presenting difficulty, case closure reason, suggests that CYP from Asian backgrounds (OR = 0.82, CI [0.70, 0.96]) and Mixed-race (odds ratio (OR) = 0.80; 95% CI [0.69, 0.92]) are less likely to report measurable improvement in mental health difficulties compared to White British CYP. Three themes from a thematic analysis of semi-structured interviews with 15 CYP from minoritized ethnic backgrounds focused on views and experiences of ending mental health support are also presented. CYP view personalised support and the right therapist as conducive to good endings and valued a range of outcomes pertaining to empowerment. Experiences of stigma and inequalities may begin to explain the less positive outcomes experienced by Asian and Mixed-race CYP found in the regression analysis. The implications of these findings and future areas of research are suggested.
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Affiliation(s)
- H Ruphrect-Smith
- Clinical, Educational, and Health Psychology, University College London, London, UK
| | - S Davies
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK
| | - J Jacob
- Clinical, Educational, and Health Psychology, University College London, London, UK
- Child Outcomes Research Consortium, Anna Freud, London, UK
| | - J Edbrooke-Childs
- Clinical, Educational, and Health Psychology, University College London, London, UK.
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK.
- Child Outcomes Research Consortium, Anna Freud, London, UK.
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Graaf G, Kitchens K, Sweeney M, Thomas KC. Behavioral Health Services Outcomes That Matter Most to Caregivers of Children, Youth, and Young Adults with Mental Health Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:172. [PMID: 38397663 PMCID: PMC10887955 DOI: 10.3390/ijerph21020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 02/25/2024]
Abstract
This project documents the service outcomes that caregivers value most. A diverse group of caregivers, representing six regions of the United States, participated in two rounds of virtual one-hour focus groups. In round 1, participants identified what they hoped to gain from using behavioral health services for themselves, their families, and their child and discussed what made services a positive experience for them. They then reported their top-three most-hoped-for outcomes. In round 2, groups validated and refined summary findings from round 1. Caregivers prioritized service quality outcomes, primarily. They expressed a desire for an accessible, respectful, and supportive treatment environment, underpinned by well-trained and culturally responsive professionals. Caregivers also desire seamless cross-sector provider collaboration and care transitions, which integrate the insights and preferences of families and children themselves to craft a customized care plan. Priority outcomes not related to service quality included hoping to gain increased knowledge, resources, and tools and techniques to support the mental health needs of their children, to see their children improve their daily functioning and for their child develop more effective interpersonal communication skills. Caregivers also reported hoping to experience less stigma related to the mental health needs of their children and to achieve personal fulfillment for themselves and their children. Research, policies, and mental health services should prioritize and be designed to address the outcomes that matter to youth and families.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Katherine Kitchens
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Millie Sweeney
- Family-Run Executive Director Leadership Association (FREDLA), Elliot City, MD 21042, USA
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599, USA
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Garza C, Chapa D, Hernandez C, Aramburu H, Mayes TL, Emslie GJ. Measurement-Based Care for Depression in Youth: Practical Considerations for Selecting Measures to Assess Depression, Associated Features and Functioning. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01652-4. [PMID: 38217644 DOI: 10.1007/s10578-023-01652-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/15/2024]
Abstract
Identification and management of major depressive disorder (MDD) in children and adolescents remains a significant area of public health need. The process for identifying depression (e.g. screening) and management (e.g. measurement based care [MBC]) is substantially enhanced by utilization of clinical measures and rating scales. Measures can be self- or caregiver reported or clinician rated. They can aid recognition of at-risk individuals for future assessment and assist in clinical diagnosis and management of depression. In addition to assessing symptoms of depression, rating scales can be used to assess important associated features (e.g. anxiety, trauma) and functional outcomes (e.g. quality of life, performance/productivity). In this manuscript, we discuss practical considerations for clinicians and researchers when selecting rating instruments for assessing depression, associated factors, functioning, and treatment outcomes (i.e. adherence and side effects) as part of MBC in youth and provide a summary of rating scales commonly used in research and clinical settings.
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Affiliation(s)
- Cynthia Garza
- Department of Psychiatry, University of Texas Rio Grande Valley, Harlingen, TX, USA.
| | - Diana Chapa
- Department of Psychiatry, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Catherine Hernandez
- Department of Psychiatry, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Hayley Aramburu
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Graham J Emslie
- Children's Health, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Krause KR, Calderón A, Pino VG, Edbrooke-Childs J, Moltrecht B, Wolpert M. What treatment outcomes matter in adolescent depression? A Q-study of priority profiles among mental health practitioners in the UK and Chile. Eur Child Adolesc Psychiatry 2024; 33:151-166. [PMID: 36719524 PMCID: PMC10806045 DOI: 10.1007/s00787-023-02140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Karolin Rose Krause
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK.
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
| | - Ana Calderón
- Facultad de Psicología y Humanidades, Universidad San Sebastián, Sede Santiago, Chile
| | - Victor Gomez Pino
- Facultad de Medicina, Departamento de Psiquiatría Norte, Hospital Clínico, Clínica Psiquiátrica Universitaria, Universidad de Chile, Avenida La Paz 1003, Recoleta, Chile
| | - Julian Edbrooke-Childs
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
| | - Bettina Moltrecht
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
- Centre for Longitudinal Studies, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK
| | - Miranda Wolpert
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE, UK
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Shenderovich Y, Piolanti A, Babii V, Calovska-Hertzog N, Evans RE, Heinrichs N, Burgund Isakov A, Lesco G, Moore G, Mueller J, Raleva M, Shimbov B, Simon J, Waller F, Wienand D, Foran HM. Family-focused intervention to promote adolescent mental health and well-being in Moldova and North Macedonia (FLOURISH): feasibility study protocol. BMJ Open 2023; 13:e080400. [PMID: 38072469 PMCID: PMC11148709 DOI: 10.1136/bmjopen-2023-080400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Family-Focused Adolescent & Lifelong Health Promotion (FLOURISH) project will adapt, implement and evaluate a programme to support adolescent mental health and well-being through strategies, such as strengthening parenting practices, adolescent-caregiver relationships, adolescent and parent socioemotional skills, and social support. METHODS AND ANALYSIS The project will focus on adolescents aged 10-14 years and their caregivers in North Macedonia and Moldova. The countries were selected based on implementation readiness of two organisations and a need for accessible evidence-informed services to help mitigate health risks due to economic, social and political challenges. Parenting for Lifelong Health (PLH) for Parents and Teens is a family-based programme developed for low-resource settings. PLH has been adapted with input from advisory groups. The programme includes additional components to strengthen impacts on adolescents: adolescent mental health tools, based on UNICEF's Helping Adolescents Thrive, adolescent peer support and participation booster. This pilot is first of three study phases. The pilot will be a feasibility testing of the adapted intervention and the assessment and implementation procedures to determine further refinements. The pilot will examine if the adapted programme is acceptable for adolescents, their families and providers, explore contextual factors relevant to embedding this programme into longer-term scale-up and investigate whether the programme can be delivered with fidelity and participation; whether the participants report changes in adolescent emotional and behavioural problems, well-being and other outcomes; and whether the study tools are feasible and appropriate. Pre-post adolescent and caregiver questionnaires will provide outcome data. Process evaluation will include attendance and fidelity data, and focus groups. We will examine delivery cost and resource requirements. ETHICS AND DISSEMINATION The study was approved at the University of Klagenfurt (Austria), Medical Faculty at St. Cyril and Methodius University (North Macedonia) and National Committee of Ethical Expertise for Clinical Trials (Moldova). Through stakeholder engagement and dissemination, FLOURISH will advance scale-up of open-source family interventions. TRIAL REGISTRATION NUMBER Trial registration: ID101095528; project page: https://www.flourish-study.org/about.html; https://www.linkedin.com/company/flourish-study/.
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Affiliation(s)
- Yulia Shenderovich
- Centre for the Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Antonio Piolanti
- Institute of Psychology, University of Klagenfurt, Klagenfurt, Austria
| | - Viorel Babii
- Asociatia Obsteasca Sanatate Pentru Tineri (Health for Youth Association), Chisinau, Moldova
| | - Nevena Calovska-Hertzog
- Department for Psychology, Faculty for Media and Communication, Singidunum University, Belgrade, Serbia
- AST Centre for Education, Belgrade, Serbia
| | - Rhiannon E Evans
- Centre for the Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Nina Heinrichs
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Anita Burgund Isakov
- Faculty of Political Sciences, Department of Social Policy and Social Work, University of Belgrade, Belgrade, Serbia
| | - Galina Lesco
- Asociatia Obsteasca Sanatate Pentru Tineri (Health for Youth Association), Chisinau, Moldova
| | - Graham Moore
- Centre for the Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Janina Mueller
- Institute of Psychology, University of Klagenfurt, Klagenfurt, Austria
| | - Marija Raleva
- Institute for Marriage, Family and Systemic Practice-ALTERNATIVA, Skopje, North Macedonia
- Department of Child and Adolescent Psychiatry, Ss Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Bojan Shimbov
- Instituto de Economía Internacional, Department of Economics, University Jaume I Castellon, Castellón de la Plana, Spain
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford University, Oxford, Oxfordshire, UK
| | - Franziska Waller
- Institute of Psychology, University of Klagenfurt, Klagenfurt, Austria
| | - Dennis Wienand
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Heather M Foran
- Institute of Psychology, University of Klagenfurt, Klagenfurt, Austria
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Marconi E, Monti L, Fredda G, Kotzalidis GD, Janiri D, Zani V, Vitaletti D, Simone MV, Piciollo S, Moriconi F, Di Pietro E, Popolo R, Dimaggio G, Veredice C, Sani G, Chieffo DPR. Outpatient care for adolescents' and young adults' mental health: promoting self- and others' understanding through a metacognitive interpersonal therapy-informed psychological intervention. Front Psychiatry 2023; 14:1221158. [PMID: 38025443 PMCID: PMC10651761 DOI: 10.3389/fpsyt.2023.1221158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Psychological distress may result in impairment and difficulty understanding oneself and others. Thus, addressing metacognitive issues in psychotherapy may improve psychopathology in adolescents and young adults (AYAs). We aimed to compare metacognitive interpersonal therapy (MIT)-informed psychotherapy with other treatment-as-usual (TAU) therapies. Methods We administered the Global Assessment of Functioning (GAF) scale, the Clinical Global Impressions-Severity (CGI-S) scale, and the Brief Psychiatric Rating Scale (BPRS) at baseline (BL) and at treatment termination (the endpoint was at 6 months and any last results obtained before that term were carried forward in analyzes). Patients received concomitant psychiatric and psychological treatment. Results Sixty AYAs were involved in the study. There was a significant reduction in symptomatology after the intervention. Twelve patients (17%) dropped out; treatment adherence was 83%. In the MIT group, 2 patients dropped out (11%), and in the TAU group, 9 patients dropped out (19%). All scales showed a significant reduction in symptoms between baseline (BL) and the 6-month endpoint: GAF (χ2 = 6.61, p < 0.001), BPRS (χ2 = 6.77, p < 0.001), and CGI (χ2 = 7.20, p < 0.001). There was a greater efficacy for the MIT group in terms of symptom reduction on the BPRS (t = 2.31; p < 0.05). Conclusion The study confirmed the efficacy of early and integrated care in adolescence and suggested greater symptom reduction for a psychotherapeutic intervention focused on stimulating mentalization skills. The study indicates the usefulness of this type of approach in the treatment of adolescent psychopathology. Due to the small sample size, the results need replication.
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Affiliation(s)
- Elisa Marconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Laura Monti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Fredda
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Georgios D. Kotzalidis
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), University of Rome “La Sapienza”, Rome, Italy
| | - Delfina Janiri
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Zani
- Catholic University of the Sacred Heart–Rome, Rome, Italy
| | | | | | | | - Federica Moriconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Rome, Italy
- Department of Mental Health, Rome, Italy
| | | | - Chiara Veredice
- Pediatric Neuropsychiatry Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart–Rome, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Life Sciences and Public Health Department, Catholic University of Sacred Heart, Rome, Italy
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12
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Levkovich I, Labes M. "I wanted to hide but also to be found": the high school experiences of young adults who grew up in the same home as a sibling with depression. BMC Psychol 2023; 11:190. [PMID: 37386645 DOI: 10.1186/s40359-023-01234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Depression is a mental health condition that can have far-reaching consequences for the entire family, not just for the affected individual. Siblings are particularly vulnerable in that the unremitting stress and guilt at home can affect multiple aspects of their lives, including relationships, added responsibilities, and health. This pressure may affect siblings' own emotional well-being and academic success. Most studies in this field have examined the impact of depression on the affected adolescents or their parents, whereas few have examined the impact on siblings. Sibling studies have been limited by lack of sample homogeneity, especially in the context of coping in high school. This study sought to examine the retrospective experiences of young adults who lived in the same house as a sibling with depression while they were in high school. METHODS This qualitative study examined 21 young adults (aged 18-29) who grew up with a sibling with depression. In-depth, semi-structured interviews were conducted from May to September 2022. The interviews were recorded and transcribed and underwent thematic analysis. RESULTS Three main themes emerged from the interviews: (1) "School as a place of refuge": The perspective of participants who grew up with a sibling with depression regarding their high school experience. (2) "I wanted the adults at school to see me": Relations between research participants and the school educational staff. (3) "I was afraid people would relate to me as the sibling of a crazy person": Participants' relationships with their peers. CONCLUSIONS This study sheds light on the experiences of adolescents who grew up with a sibling with depression. The findings point to feelings of being invisible, self-nullification, avoiding sharing with others, and transparency. The participants were afraid that if their peers found out about their sibling they would also be stigmatized and alienated. The study shows that adolescents living with a sibling with depression need support at school.
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Affiliation(s)
- Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tiv'on, 36006, Israel.
| | - Michal Labes
- Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tiv'on, 36006, Israel
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13
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Helle J, Vøllestad J, Schanche E, Hjelen Stige S. From seeing difficult behaviour to recognizing legitimate needs - A qualitative study of mothers' experiences of participating in a Circle of Security Parenting program in a public mental health setting. Psychother Res 2023; 33:482-493. [PMID: 36314235 DOI: 10.1080/10503307.2022.2132888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE Mental health challenges can interfere with caregivers' self-efficacy and their ability to engage with their children in developmentally appropriate ways. The goal of this study was to explore whether the intervention Circle of Security Parenting (COS-P) was experienced as a meaningful adjunct to psychological treatment. METHOD Individual qualitative semi-structured interviews were conducted with twelve female COS-P participants, exploring how taking part in COS-P had changed the way they related to themselves and others. Data were analyzed using a team-based, reflexive thematic analysis. RESULTS The analysis resulted in three main themes: (i) Connecting dots: A new perspective on one's past, (ii) Seeing oneself more clearly: Increased capacity to recognize and tend to own needs, and (iii) Gaining a map: Becoming a more competent parent. CONCLUSION Taking part in COS-P as an adjunct to psychological treatment positively impacted participants' sense of competence as mothers. They used the COS-P framework to make sense of their interaction with their child, enabling them to understand the child's behaviour and communication as expressing legitimate attachment needs. They also experienced that the course strengthened central psychological capacities, such as insight into their own developmental histories as well as increased self-awareness and self-care. Implications are discussed.
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Affiliation(s)
- Jorunn Helle
- Solli District Psychiatric Centre (DPS), Nesttun, Norway
| | - Jon Vøllestad
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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14
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Lavik KO, Veseth M, Frøysa H, Stefansen J, Nøtnes JC, Moltu C. This is what I need a clinical feedback system to do for me: A qualitative inquiry into perspectives of adolescents and their therapists. J Clin Psychol 2023; 79:729-747. [PMID: 33320330 DOI: 10.1002/jclp.23100] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 10/13/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Routine outcome monitoring and clinical feedback systems might be beneficial for adolescent psychotherapy processes. METHODS Clinicians (n = 34) and adolescent clients (n = 22) aged 14-19 from seven different outpatient clinics located in Norway participated in the study. Adolescents were interviewed in individual in-depth interviews (n = 7) or in four adolescent-only focus groups (n = 15), clinicians participated in seven clinician-only focus groups. RESULTS We report two core domains, (1) feedback about the therapeutic relationship and (2) feedback about the therapeutic work. Seven subthemes specify the functionality that participants need in a feedback system. CONCLUSION Adolescents and therapists requested a feedback system that was relationally oriented, supported collaborative action, and was personalized to the needs of the individual adolescent. The research indicates that a clinical feedback system should have idiographic, as well as nomothetic, components. A clinical feedback system for adolescents should monitor experiences of personal autonomy and the quality of the therapeutic relationship.
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Affiliation(s)
- Kristina O Lavik
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Science, Førde, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Helga Frøysa
- Department of Psychology Services, Askøy Commune, Bergen, Norway
| | - Jon Stefansen
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Jan C Nøtnes
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Science, Førde, Norway
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15
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Mehta A, Dykiert D, Midgley N. Understanding treatment non-responders: A qualitative study of depressed adolescents' experiences of 'unsuccessful' psychotherapy. Psychol Psychother 2023; 96:448-463. [PMID: 36748831 DOI: 10.1111/papt.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/30/2022] [Accepted: 01/22/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This paper aimed to explore the experiences of depressed adolescents who completed but did not 'respond' to standard psychotherapy, based on a lack of improvement in pre-post symptoms scores. DESIGN This was a qualitative study employing interpretative phenomenological analysis (IPA). METHOD Seventy-seven adolescents with moderate to severe depression were interviewed as part of a qualitative arm of a randomised controlled trial. Five adolescents' post-treatment interviews were purposively sampled, based on lack of improvement on pre-post symptom scores, and adolescents still scoring above the clinical threshold for depression. The interviews were analysed using IPA. RESULTS Adolescents made sense of their depression as part of their identity and held negative expectations of therapy. Some aspects of therapy brought up intolerable feelings that contributed to disengagement in the therapeutic process and culminated in disappointing and hopeless endings. On the other hand, where a stronger therapeutic relationship was developed, some participants experienced certain improvements. CONCLUSIONS Findings highlight how actively exploring the adolescent's therapy expectations, developing a strong early therapeutic relationship and being mindful of the potential impact of endings are important in therapeutic work with adolescents with depression, especially where they may have a strong sense of hopelessness and self-criticism. Moreover, the finding that adolescents experienced improvements in other domains despite a lack of symptom reduction highlights the need to review how treatment outcomes are currently defined. Integrating individual perspectives of therapy with quantitative outcome measures can provide a more nuanced insight of treatment effects.
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Affiliation(s)
- Alisha Mehta
- Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Dominika Dykiert
- Clinical, Educational and Health Psychology, University College London (UCL), London, UK.,The Anna Freud National Centre for Children and Families, London, UK
| | - Nick Midgley
- Clinical, Educational and Health Psychology, University College London (UCL), London, UK.,The Anna Freud National Centre for Children and Families, London, UK
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16
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Evans-Chase M, Kornmann R, Peralta B, Gliske K, Berry K, Solomon P, Fenkel C. The title has been changed to: Understanding Treatment Needs of Youth in a Remote IOP: A Quality Improvement Analysis of Solicited Journals (Preprint). JMIR Form Res 2023; 7:e45509. [PMID: 37133910 DOI: 10.2196/45509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Youth experiencing high-acuity mental health symptoms often require highly restrictive levels of care (ie, inpatient care) that removes them from the relationships and activities essential for healthy development. An alternative treatment gaining evidence in its ability to support this population is the intensive outpatient programming (IOP) model. Understanding the experiences of adolescents and young adults during IOP treatment episodes may enhance clinical responsiveness to changing needs and protect against transfer to inpatient care. OBJECTIVE The objective of the analysis reported here was to identify heretofore unrecognized treatment needs of adolescents and young adults attending a remote IOP to help the program make clinical and programmatic decisions that increase its ability to support the recovery of program participants. METHODS Treatment experiences are collected weekly via electronic journals as part of ongoing quality improvement efforts. The journals are used by clinicians proximally to help them identify youth in crisis and distally to help them better understand and respond to the needs and experiences of program participants. Journal entries are downloaded each week, reviewed by program staff for evidence of the need for immediate intervention, and later deidentified and shared with quality improvement partners via monthly uploads to a secure folder. A total of 200 entries were chosen based on inclusion criteria that focused primarily on having at least one entry at 3 specified time points across the treatment episode. Overall, 3 coders analyzed the data using open-coding thematic analysis from an essentialist perspective such that the coders sought to represent the data and thus the essential experience of the youth as closely as possible. RESULTS Three themes emerged: mental health symptoms, peer relations, and recovery. The mental health symptoms theme was not surprising, given the context within which the journals were completed and the journal instructions asking that they write about how they are feeling. The peer relations and recovery themes provided novel insight, with entries included in the peer relations theme demonstrating the central importance of peer relationships, both within and outside of the therapeutic setting. The entries contained under the recovery theme described experience of recovery in terms of increases in function and self-acceptance versus reductions in clinical symptoms. CONCLUSIONS These findings support the conceptualization of this population as youth with both mental health and developmental needs. In addition, these findings suggest that current definitions of recovery may inadvertently miss supporting and documenting treatment gains considered most important to the youth and young adults receiving care. Taken together, youth-serving IOPs may be better positioned to treat youth and assess program impact through the inclusion of functional measures and attention to fundamental tasks of the adolescent and young adult developmental periods.
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Affiliation(s)
- Michelle Evans-Chase
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Rachel Kornmann
- Behavioral Health Care, Rutgers University, New Brunswick, NJ, United States
| | | | - Kate Gliske
- Charlie Health, Inc, Bozeman, MT, United States
| | - Katie Berry
- Charlie Health, Inc, Bozeman, MT, United States
| | - Phyllis Solomon
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
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17
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Krause KR, Edbrooke-Childs J, Bear HA, Calderón A, Wolpert M. What treatment outcomes matter most? A Q-study of outcome priority profiles among youth with lived experience of depression. Eur Child Adolesc Psychiatry 2023; 32:123-137. [PMID: 34273026 PMCID: PMC9908724 DOI: 10.1007/s00787-021-01839-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 06/28/2021] [Indexed: 12/16/2022]
Abstract
Interest in youth perspectives on what constitutes an important outcome in the treatment of depression has been growing, but limited attention has been given to heterogeneity in outcome priorities, and minority viewpoints. These are important to consider for person-centred outcome tracking in clinical practice, or when conducting clinical trials targeting specific populations. This study used Q-methodology to identify outcome priority profiles among youth with lived experience of service use for depression. A purposive sample of 28 youth (aged 16-21 years) rank-ordered 35 outcome statements by importance and completed brief semi-structured interviews eliciting their sorting rationales. By-person principal component analysis was used to identify outcome priority profiles based on all Q-sort configurations. Priority profiles were described and interpreted with reference to the qualitative interview data. Four distinct outcome priority profiles were identified: "Relieving distress and experiencing a happier emotional state"; "Learning to cope with cyclical distressing emotional states"; "Understanding and processing distressing emotional states"; and "Reduced interference of ongoing distressing emotional states with daily life". All four profiles prioritised improvements in mood and the ability to feel pleasure but differed in the level of importance assigned to learning coping skills, processing experiences, and the reduced interference of depression with life and identity. As part of a person-centered approach to care delivery, care providers should routinely engage young people in conversation and shared decision-making about the types of change they would like to prioritise and track during treatment, beyond a common core of consensus outcomes.
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Affiliation(s)
- Karolin Rose Krause
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK. .,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT, UK. .,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH UK ,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK
| | - Holly Alice Bear
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH UK ,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK ,Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, M6J 1H4 UK
| | - Ana Calderón
- School of Psychology, Universidad Gabriela Mistral, Avda. Ricardo Lyon 1177, Providencia, Santiago, Chile
| | - Miranda Wolpert
- Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK ,Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE UK
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18
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Krause KR, Hetrick SE, Courtney DB, Cost KT, Butcher NJ, Offringa M, Monga S, Henderson J, Szatmari P. How much is enough? Considering minimally important change in youth mental health outcomes. Lancet Psychiatry 2022; 9:992-998. [PMID: 36403601 DOI: 10.1016/s2215-0366(22)00338-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/19/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022]
Abstract
To make decisions in mental health care, service users, clinicians, and administrators need to make sense of research findings. Unfortunately, study results are often presented as raw questionnaire scores at different time points and regression coefficients, which are difficult to interpret with regards to their clinical meaning. Other commonly reported treatment outcome indicators in clinical trials or meta-analyses do not convey whether a given change score would make a noticeable difference to service users. There is an urgent need to improve the interpretability and relevance of outcome indicators in youth mental health (aged 12-24 years), in which shared decision making and person-centred care are cornerstones of an ongoing global transformation of care. In this Personal View, we make a case for considering minimally important change (MIC) as a meaningful, accessible, and user-centred outcome indicator. We discuss what the MIC represents, how it is calculated, and how it can be implemented in dialogues between clinician and researcher, and between youth and clinician. We outline how use of the MIC could enhance reporting in clinical trials, meta-analyses, clinical practice guidelines, and measurement-based care. Finally, we identify current methodological challenges around estimating the MIC and areas for future research. Efforts to select outcome domains and valid measurement instruments that resonate with youth, families, and clinicians have increased in the past 5 years. In this context, now is the time to define demarcations of changes in outcome scores that are clinically relevant, and meaningful to youth and families. Through the use of MIC, youth-centred outcome measurement, analysis, and reporting would support youth-centred therapeutic decision making.
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Affiliation(s)
- Karolin R Krause
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Sarah E Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; The Werry Centre, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Darren B Courtney
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Suneeta Monga
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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19
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Thapar A, Eyre O, Patel V, Brent D. Depression in young people. Lancet 2022; 400:617-631. [PMID: 35940184 DOI: 10.1016/s0140-6736(22)01012-1] [Citation(s) in RCA: 148] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023]
Abstract
Depression rates in young people have risen sharply in the past decade, especially in females, which is of concern because adolescence is a period of rapid social, emotional, and cognitive development and key life transitions. Adverse outcomes associated with depression in young people include depression recurrence; the onset of other psychiatric disorders; and wider, protracted impairments in interpersonal, social, educational, and occupational functioning. Thus, prevention and early intervention for depression in young people are priorities. Preventive and early intervention strategies typically target predisposing factors, antecedents, and symptoms of depression. Young people who have a family history of depression, exposure to social stressors (eg, bullying, discordant relationships, or stressful life events), and belong to certain subgroups (eg, having a chronic physical health problem or being a sexual minority) are at especially high risk of depression. Clinical antecedents include depressive symptoms, anxiety, and irritability. Evidence favours indicated prevention and targeted prevention to universal prevention. Emerging school-based and community-based social interventions show some promise. Depression is highly heterogeneous; therefore, a stepwise treatment approach is recommended, starting with brief psychosocial interventions, then a specific psychological therapy, and then an antidepressant medication.
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Affiliation(s)
- Anita Thapar
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK.
| | - Olga Eyre
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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20
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Edbrooke-Childs J, Rashid A, Ritchie B, Deighton J. Predictors of child and adolescent mental health treatment outcome. BMC Psychiatry 2022; 22:229. [PMID: 35361193 PMCID: PMC8973575 DOI: 10.1186/s12888-022-03837-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To examine the predictors of treatment outcome or improvement in mental health difficulties for young people accessing child and adolescent mental health services. METHODS We conducted a secondary analysis of routinely collected data from services in England using the Mental Health Services Data Set. We conducted multilevel regressions on N = 5907 episodes from 14 services (Mage = 13.76 years, SDage = 2.45, range = 8-25 years; 3540 or 59.93% female) with complete information on mental health difficulties at baseline. We conduct similar analyses on N = 1805 episodes from 10 services (Mage = 13.59 years, SDage = 2.33, range = 8-24 years; 1120 or 62.05% female) also with complete information on mental health difficulties at follow up. RESULTS Girls had higher levels of mental health difficulties at baseline than boys (β = 0.28, 95% CI = 0.24-0.32). Young people with higher levels of mental health difficulties at baseline also had higher levels of deterioration in mental health difficulties at follow up (β = 0.72, 95% CI = 0.67-0.76), and girls had higher levels of deterioration in mental health difficulties at follow up than boys (β = 0.09, 95% CI = 0.03-0.16). Young people with social anxiety, panic disorder, low mood, or self-harm had higher levels of mental health difficulties at baseline and of deterioration in mental health difficulties at follow up compared to young people without these presenting problems. CONCLUSIONS Services seeing higher proportions of young people with higher levels of mental health difficulties at baseline, social anxiety, panic disorder, low mood, or self-harm may be expected to show lower levels of improvement in mental health difficulties at follow up.
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Affiliation(s)
- Julian Edbrooke-Childs
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 4-8 Rodney Street, London, N1 9JH, UK. .,Child Outcomes Research Consortium, Anna Freud Centre, London, UK.
| | - Anisatu Rashid
- grid.466510.00000 0004 0423 5990Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Benjamin Ritchie
- grid.466510.00000 0004 0423 5990Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Jessica Deighton
- grid.466510.00000 0004 0423 5990Evidence Based Practice Unit, UCL and Anna Freud Centre, 4-8 Rodney Street, London, N1 9JH UK
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21
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Sibeoni J, Orri M, Manolios E, Spodenkiewicz M, Labey M, Verneuil L, Revah-Levy A. Early-treatment stage for adolescents with depression and their parents: An IPSE qualitative study. Eur Child Adolesc Psychiatry 2022:10.1007/s00787-022-01952-5. [PMID: 35124719 DOI: 10.1007/s00787-022-01952-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/22/2022] [Indexed: 12/18/2022]
Abstract
The period at the start of treatment of adolescents with depression is both crucial and complex. Adolescents' and parents' perspectives on that early-treatment stage are important but have not yet been explored. The present study explores the lived experience of the early-treatment stage among adolescents with major depressive disorder and their parents and aims to cross their perspectives. This French qualitative multicentre study followed the five stages IPSE approach. Semi-structured interviews with adolescents with depression and with their parents were conducted. Data collection by purposive sampling continued until we reached theoretical sufficiency. Forty-seven participants-20 adolescents, 27 parents-were included. Data analysis produced a structure of lived experience based on two axes: (1) what leads to care: what is shown, what is seen, describing a dynamic process of showing and seeing around the start of treatment and (2) the start of treatment: knowing and sharing everyone's explanations. Results suggest some early therapeutic alliance facilitators, that is, first to be able to see the depressive manifestations and directly address the issue of depression based on what is shown and seen, second to give the opportunity to both adolescents and parents to share their views and explanations about the adolescent's distress, and finally to explicitly name this distress depression to first agree on the term to use.
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Affiliation(s)
- Jordan Sibeoni
- Service Universitaire de Psychiatrie de L'Adolescent, Argenteuil Hospital Centre, 69 Rue du Lieutenant Colonel Prudhon, 95100, Argenteuil, France.
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France.
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Québec, Canada
- Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux, Bordeaux, France
| | - Emilie Manolios
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
- Service de Psychologie Et Psychiatrie de Liaison Et d'Urgences, Hôpital Européen Georges Pompidou AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France
| | - Michel Spodenkiewicz
- Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, Institut Des Systèmes Intelligents Et de Robotique, Paris, France
- CEPOI EA 7388, Unité de Pédopsychiatrie de Liaison, Pôle de Santé Mentale, CHU Sud Réunion, Université de La Réunion, Saint-Pierre, France
- Groupe IPSOM, CESP Inserm U1178, Paris, France
| | - Mathilde Labey
- Hôpitaux de Saint-Maurice, pôle de psychiatrie adulte Paris 11, Saint-Maurice, France
| | - Laurence Verneuil
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
- Pôle Précarité, GHU Paris psychiatrie & neurosciences Site Sainte-Anne, Paris, France
| | - Anne Revah-Levy
- Service Universitaire de Psychiatrie de L'Adolescent, Argenteuil Hospital Centre, 69 Rue du Lieutenant Colonel Prudhon, 95100, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
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22
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Stringaris A. Sources of normativity in childhood depression. Eur Child Adolesc Psychiatry 2021; 30:1663-1665. [PMID: 34687389 DOI: 10.1007/s00787-021-01891-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Argyris Stringaris
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
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23
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Smith K, McLeod J, Blunden N, Cooper M, Gabriel L, Kupfer C, McLeod J, Murphie MC, Oddli HW, Thurston M, Winter LA. A Pluralistic Perspective on Research in Psychotherapy: Harnessing Passion, Difference and Dialogue to Promote Justice and Relevance. Front Psychol 2021; 12:742676. [PMID: 34552542 PMCID: PMC8450328 DOI: 10.3389/fpsyg.2021.742676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
The adoption of a pluralistic perspective on research design, processes of data collection and analysis and dissemination of findings, has the potential to enable psychotherapy research to make a more effective contribution to building a just society. A review of the key features of the concept of pluralism is followed by a historical analysis of the ways in which research in counselling, psychotherapy and related disciplines has moved in the direction of a pluralistic position around knowledge creation. Core principles of a pluralistic approach to research are identified and explored in the context of a critical case study of contemporary research into psychotherapy for depression, examples of pluralistically oriented research practices, and analysis of a pluralistic conceptualisation of the nature of evidence. Implications of a pluralistic perspective for research training and practice are discussed. Pluralistic inquiry that emphasises dialogue, collaboration, epistemic justice and the co-existence of multiple truths, creates opportunities for individuals, families and communities from a wide range of backgrounds to co-produce knowledge in ways that support their capacities for active citizenship and involvement in open democratic decision-making. To fulfil these possibilities, it is necessary for psychotherapy research to be oriented towards social goals that are sufficiently relevant to both researchers and co-participants to harness their passion and work together for a common good.
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Affiliation(s)
- Kate Smith
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - John McLeod
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | | | - Mick Cooper
- Department of Psychology, Roehampton University, London, United Kingdom
| | - Lynne Gabriel
- School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Christine Kupfer
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Julia McLeod
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | | | - Hanne Weie Oddli
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Mhairi Thurston
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Laura Anne Winter
- Manchester Institute of Education, Schools of Environment, Education, and Development, University of Manchester, Manchester, United Kingdom
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24
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Housby H, Thackeray L, Midgley N. What contributes to good outcomes? The perspective of young people on short-term psychoanalytic psychotherapy for depressed adolescents. PLoS One 2021; 16:e0257334. [PMID: 34559829 PMCID: PMC8462705 DOI: 10.1371/journal.pone.0257334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/29/2021] [Indexed: 12/03/2022] Open
Abstract
Depression is the fourth leading cause of adolescent illness and disability worldwide. A growing evidence base demonstrates that Short Term Psychoanalytic Psychotherapy [STPP] is an efficacious treatment for moderate to severe adolescent depression. However, with research in its infancy, key factors contributing to efficacy are unknown. Service users' lived experiences provide valuable insight in this area. This study aimed to elucidate what adolescents value in treatment by inductively exploring lived experiences of STPP. Five adolescents with the largest reduction in depressive symptoms scores between baseline and end of treatment, who had taken part in a large-scale randomized controlled trial, were sampled. In-depth interviews carried out soon after the end of therapy were analysed using Interpretative Phenomenological Analysis. Three superordinate themes were identified: "Therapy as a Transformational Process", "Explorative and Exposing: The Therapeutic Space" and "Being Heard and Working Together: The Therapeutic Relationship". Adolescents valued a process of collaborative exploration with the therapist which when it was achieved was felt to facilitate a deep-rooted transformation in self-perception. Additionally, they described how an adjustment was needed to the particular frame of a psychoanalytic therapy. However, not all participants with a good treatment outcome experienced therapy in this way, suggesting a potential gap between the quantitative assessment of outcomes, and the way young people experience and understand the change process. Clinical implications and directions for research are discussed.
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Affiliation(s)
- Harriet Housby
- Research Department of Clinical, Educational and Health Psychology, University College London, London [UCL], United Kingdom
| | - Lisa Thackeray
- Research Department of Clinical, Educational and Health Psychology, University College London, London [UCL], United Kingdom
- Child Attachment and Psychological Therapies Research Unit [ChAPTRe], Anna Freud Centre, London, United Kingdom
| | - Nick Midgley
- Research Department of Clinical, Educational and Health Psychology, University College London, London [UCL], United Kingdom
- Child Attachment and Psychological Therapies Research Unit [ChAPTRe], Anna Freud Centre, London, United Kingdom
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25
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Bear HA, Dalzell K, Edbrooke-Childs J, Garland L, Wolpert M. How to manage endings in unsuccessful therapy: A qualitative comparison of youth and clinician perspectives. Psychother Res 2021; 32:249-262. [PMID: 33950789 DOI: 10.1080/10503307.2021.1921304] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Approximately half of those who access child and adolescent mental health services do not show measurable improvement in symptoms. This study aimed to provide practice recommendations for managing treatment endings, particularly when outcomes have not improved. Method: Semi-structured interviews were carried out with 26 young people with a history of anxiety and/or depression along with 7 roundtable sessions with 52 mental health clinicians. Data were analyzed using Framework Analysis. Results: A common experience for young people when outcomes did not improve was a poor experience of the treatment ending, which often resulted in setbacks in their mental health and feelings of loss and abandonment. Clinicians agreed that ending was hard for young people and reported that they found managing ending hard on a personal and professional level. This was compounded by unrealistically high public expectations about the impact of therapy on outcomes and trying to strike a balance between fostering hope and managing expectations, within a context of inflexible service structures and resource constraint. Implications: Recommendations include establishing expectations from the outset and a shared understanding of what outcomes matter most to the young person. This can be achieved through communicating honestly about likely outcomes, while also providing hope.
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Affiliation(s)
- Holly Alice Bear
- Research Department for Clinical, Educational and Health Psychology, University College London, London, UK.,Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, UK.,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Kate Dalzell
- Child Outcomes Research Consortium, The Kantor Centre of Excellence, London, UK
| | - Julian Edbrooke-Childs
- Research Department for Clinical, Educational and Health Psychology, University College London, London, UK.,Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, UK.,Child Outcomes Research Consortium, The Kantor Centre of Excellence, London, UK
| | - Lauren Garland
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, UK
| | - Miranda Wolpert
- Research Department for Clinical, Educational and Health Psychology, University College London, London, UK.,Wellcome Trust, London, UK
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26
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Stänicke E, McLeod J. Paradoxical outcomes in psychotherapy: Theoretical perspectives, research agenda and practice implications. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2021. [DOI: 10.1080/13642537.2021.1923050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - John McLeod
- Department of Psychology, University of Oslo
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