Client-Focused Research: New Directions in Outcome Assessment

Progress monitoring and feedback in psychiatric care reduces depressive symptoms

BACKGROUND

To date, the monitoring of patient progress using standardized assessments has been neglected in hospital-based psychiatric care. Findings in outpatient psychotherapy have demonstrated clinically significant benefits for providing feedback to the sizeable minority of patients who were otherwise unlikely to experience positive outcome (Lambert, 2007). However, a similar system for presenting feedback on patient progress has not yet been assessed for group therapy within psychiatric inpatient settings. The current study aimed to develop and evaluate the effectiveness of a feedback system suitable for use in psychiatric services.

METHODS

In a nonrandomized trial, 1308 consecutive inpatients and day patients, whose diagnoses were primarily depressive and anxiety disorders, completed the World Health Organization's Wellbeing Index (WHO-5) routinely during a ten-day cognitive behavioral therapy group. The first cohort (n=461) received treatment as usual. The second cohort (n=439) completed monitoring measures without feedback, and for patients in the third cohort (n=408), feedback on progress was provided to both clinicians and patients midway through the treatment period.

RESULTS

Feedback was effective in reducing depressive symptoms (F(1,649)=6.29, p<.05) for those patients at risk of poor outcome, but not effective in improving wellbeing (F(1,569)=1.14, p>.05).

LIMITATIONS

The current findings may be generalized to patient samples that exhibit largely depressive disorders, however rigorous follow-up is warranted.

CONCLUSIONS

Similar to outpatient settings, feedback appears to be beneficial for improving symptom outcomes but further time may be required for wellbeing to be affected.

Monitoring treatment response and outcomes using the World Health Organization's Wellbeing Index in psychiatric care

BACKGROUND

Effective psychiatric care requires reliable measurement of patient progress and outcome. The current study aimed to assess the clinical validity of the WHO Wellbeing Index (WHO-5; Bech, P., Gudex, C., Johansen, K.S., 1996. The WHO (Ten) Wellbeing Index: validation in diabetes. Psychotherapy and Psychosomatics 65, 183-190.) for use as a measure of individual treatment response and outcome in mental health care.

METHOD

Three hundred and eighteen consecutive inpatients and day patients at an Australian private psychiatric facility completed the WHO-5, SF-36 and DASS-21 routinely during treatment, and 152 undergraduate students completed the WH0-5.

RESULTS

The WHO-5 was shown to be a measure with high reliability, validity and sensitivity to change, for use with patients who have affective or neurotic primary diagnoses. Further to this, regression analyses demonstrated that early scores on the measure predicted final outcome. Criteria for clinically significant recovery are also presented.

LIMITATIONS

The results may be generalized to samples with primary diagnoses of affective and anxiety disorders. Assessment of the WHO-5 as a measure of treatment response is warranted in other patient samples.

CONCLUSIONS

The current findings illustrate the potential of the WHO-5 as a quick, reliable and valid means for assessing patient outcome and monitoring patient response to treatment in psychiatric services.