What treatment outcomes matter in adolescent depression? A Q-study of priority profiles among mental health practitioners in the UK and Chile

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.

How do we know whether treatment has failed? Paradoxical outcomes in counseling with young people

“…Based on these results, treatment failure or success is not a straightforward matter. These results are consistent with findings of other studies that have similarly reported differences between outcomes recorded through self-report measures and those based on qualitative interviews (McElvaney and Timulak, 2013;Bloch-Elkouby et al, 2019;De Smet et al, 2019, 2020a,b, 2021a,b, 2024Desmet et al, 2021a). Taken together, the evidence from these studies as a whole suggest that the phenomenon that we have characterized as paradoxical outcome is a robust pattern that has been identified in different samples using different data collection and analysis strategies.…”

“…There are several factors that may contribute to the occurrence of paradoxical outcomes. When evaluating the effectiveness of therapy they have received, clients make reference to a much wider range of criteria than those covered by commonly-used symptom measures ( Chevance et al, 2020 ; Bear et al, 2021 ; Housby et al, 2021 ; Krause et al, 2021 ; Axelsdóttir et al, 2022 ; Morton et al, 2022 ; Amin Choudhury et al, 2023 ; Kohne et al, 2023 ; Krause et al, 2024 ). As a consequence, in a post-therapy interview, a client may judge therapy to be successful or otherwise on the basis of factors that are not measured in an outcome scale.…”

Table_1.DOCX

“…There are several factors that may contribute to the occurrence of paradoxical outcomes. When evaluating the effectiveness of therapy they have received, clients make reference to a much wider range of criteria than those covered by commonly-used symptom measures (Chevance et al, 2020;Bear et al, 2021;Housby et al, 2021;Krause et al, 2021;Axelsdóttir et al, 2022;Morton et al, 2022;Amin Choudhury et al, 2023;Kohne et al, 2023;Krause et al, 2024). As a consequence, in a post-therapy interview, a client may judge therapy to be successful or otherwise on the basis of factors that are not measured in an outcome scale.…”