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Patient reported outcomes (PROs) are reports of health conditions that come directly from patients. Use of PROs has been associated with improved patient outcomes, enhanced quality of life, and reduced end-of-life spending. Yet there are still outstanding questions regarding the process of implementing PRO collection in routine practice. In this article, we describe the experience of selecting and implementing PROs in a multisite, multidisease academic medical center-based radiation oncology practice and demonstrate that such large-scale rollout is feasible. We establish that PROs can be implemented with minimal to no workflow delays, are generally seen as valuable by clinicians, and can enhance patient-doctor communication. We additionally detail the challenges involved in selecting clinically relevant PRO questionnaires and the centrality of physician buy-in, easy data access, and clear workflows to successful implementation.

We examined the epidemiology and phenomenology of major depressive disorder (MDD) and minor depression among a community sample of 496 female adolescents. Diagnostic interviews were conducted annually for 7 years, allowing us to examine onset, course, and symptom presentation among participants 12 through 20 years old. Approximately 1 of 6 girls experienced MDD. MDD episodes had a mean duration of 5.3 months (SD = 4.2). One-year prevalence for MDD peaked at age 16 (5.3%). White racial status and younger age were associated with greater worthlessness and suicidality during an MDD episode. One of 5 girls met criteria for minor depression. Adolescents from racial/ethnic minority groups were at especially high risk for minor depression. Adolescence is a high-risk period for depression in young women, although its prevalence and phenomenology vary as a function of age and race/ethnicity.

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Objective The relationship between improvements in child anxiety and changes in parent factors (e.g., parental anxiety, parenting behaviors) is poorly understood. The present study investigated the directionality of change for child anxiety and parent factors among youth treated for anxiety disorders. Method Structural equation modeling examined these relationships pre- to post-treatment and at 1-year follow-up for 111 youth aged 7–14 (57% male, 84% Caucasian). Child anxiety was measured using the Anxiety Disorders Interview Schedule for Children and the Child Behavior Checklist. The State-Trait Anxiety Inventory, Children’s Report of Parental Behavior Inventory, and Family Assessment Device were used to measure maternal anxiety, psychological control, behavior control, and family affective involvement. Results Findings suggest that decreases in mother-reported child anxiety led to decreases in maternal anxiety. Decreases in maternal psychological control and family affective involvement preceded decreases in clinician-rated child anxiety. Youth who showed the most reductions in anxiety over the course of treatment were those who tended to have lower family affective involvement, behavior control, and maternal anxiety at pretreatment. Stability of the parent factors and child anxiety over time suggest that stability was greater for behavior control and maternal anxiety relative to affective involvement and psychological control. Conclusions The findings are consistent with previous research indicating the importance of these parent factors as they relate to anxiety in youth. Furthermore, results indicate that changes in child anxiety may precede changes in parent factors and suggest that psychological control and affective involvement are important treatment targets for youth with anxiety disorders.

Overall, intervention effects tended to be amplified for high-risk versus low-risk adolescents. However, certain moderator effects appeared to be specific to the two different prevention programs.

Research indicates that depression and anxiety are highly comorbid in youth. Little is known, however, about the clinical and family characteristics of youth with principal anxiety disorders and comorbid depressive diagnoses. The present study examined the demographic, clinical, and family characteristics of 200 anxiety-disordered children and adolescents (aged 7-17) with and without comorbid depressive disorders (major depressive disorder or dysthymic disorder), seeking treatment at a university-based anxiety clinic. All participants met DSM-IV diagnostic criteria for a principal anxiety disorder (generalized anxiety disorder, separation anxiety disorder, or social phobia). Of these, twelve percent (n = 24) also met criteria for a comorbid depressive disorder. Results suggest that anxiety-disordered youth with comorbid depressive disorders (AD-DD) were older at intake, had more severe anxious and depressive symptomatology, and were more impaired than anxiety-disordered youth without comorbid depressive disorders (AD-NDD). AD-DD youth also reported significantly more family dysfunction than AD-NDD youth. Future research should examine how this diagnostic and family profile may impact treatment for AD-DD youth.

Background Subjective Units of Distress Scale (SUDS) ratings are commonly used during exposure tasks in cognitive behavioral treatment (CBT) for anxiety. Aims The present study examined patterns and predictors of SUDS in a sample of anxiety-disordered youth. Method Youth (N = 99) aged 7 to 14 (M = 10.4, SD = 1.8) were treated with CBT for social phobia (SP), generalized anxiety disorder (GAD), and/or separation anxiety disorder (SAD). Analyses were conducted using hierarchical linear modeling. Results Child’s peak SUDS and magnitude of change in SUDS significantly increased between sessions. Higher child self-reported pretreatment total Multidimensional Anxiety Scale for Children (MASC) score predicted greater change in SUDS within the first exposure session. Primary GAD diagnosis predicted less increase in change in SUDS between sessions. Conclusions Results suggest that higher pretreatment total MASC scores are associated with increased first exposure within-session habituation. Additionally, youth with a principal diagnosis of GAD experienced less between-session habituation, perhaps because they may have required more imaginal than in-vivo exposures.