What treatment outcomes matter most? A Q-study of outcome priority profiles among youth with lived experience of depression

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.

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

“…In a previous Q-study involving a sample of youth with lived experience of depression, we identified four outcome priority profiles. Youth, respectively, focused on “ 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 ” [ 40 ]. The first youth profile conveyed a similar focus on symptom reduction and enhanced well-being as the practitioner super profile A super .…”

“…The Q-set used in the present study was developed through a multi-stage process involving stakeholder workshops, a systematic review of youth depression treatment studies [ 28 ]; and a qualitative analysis of youth and clinicians’ outcome narratives following treatment for depression [ 31 ]. A detailed description of this process has been published elsewhere [ 40 ]. The final Q-set consisted of 35 cards, each of which carried an outcome description.…”

“…A recent study using Q-methodology (i.e., a card sorting exercise and factorial analysis to identify sorting patterns among participants) identified four outcome priority profiles among youth aged 16–21 years with experience of depression. While all profiles prioritized outcomes related to improved mood and reduced anhedonia, the youth differed in the importance assigned to the acquisition of coping skills, to the processing of past and current experiences, and to reduced functional impairment [ 40 ]. Similar insights about heterogeneity in outcome priorities are lacking for practitioners treating youth for depression, though Q-methodological studies have explored practitioners’ perspectives on recovery from adult psychosis [ 41 ], and adult borderline personality disorder [ 42 ].…”

Examining Psychotherapeutic Processes with Depressed Adolescents: A Comparative Study of Two Psychodynamic Therapies

“…In addition to answering our research questions, we propose further reflections regarding the two cases and its implications. We know from previous research in the field of personal recovery that we need to take the clients’ subjective account into consideration when establishing the outcome of treatments [ 56 ]. Although both patients reported reduced depressive symptoms at follow-up, Sonja’s subjective experience one year after treatment was that nothing had improved or that she might even be feeling worse.…”

Children’s perspectives on being absorbed when reading fiction: A Q methodology study

“…Q methodology research with children and adolescents has appeared in many disciplines including childhood and youth studies ( Kerpelman et al, 2002 ; Metzger et al, 2016 ), psychology ( Richards et al, 2007 ; Krause et al, 2021 ), and primary education ( Tan et al, 2015 ). To our knowledge there have not been any Q studies conducted with children or adolescents regarding their reading experience, despite the method’s increasing acceptance in both compulsory education research ( Lundberg et al, 2020 ) and audience research ( Davis and Michelle, 2011 ).…”